Human leukocyte antigen molecular mismatch to risk stratify kidney transplant recipients.

@article{Wiebe2019HumanLA,  title={Human leukocyte antigen molecular mismatch to risk stratify kidney transplant recipients.},  author={Chris Wiebe and Peter W Nickerson},  journal={Current Opinion in Organ Transplantation},  year={2019},  url={https://api.semanticscholar.org/CorpusID:208537995}}
HLA molecular mismatch may represent a fast, reproducible, cost-effective, way to improve alloimmune risk assessment at the time of transplantation to move the field towards precision medicine.

24 Citations

HLA Genotype Imputation Results in Largely Accurate Epitope Mismatch Risk Categorization Across Racial Groups

Data demonstrate that imputation preserves the molecular mismatch risk assessment in the vast majority of cases and provides evidence supporting imputation in the performance of molecular mismatch analysis for clinical assessment.

Variations in de novo donor-specific antibody development among HLA-DQ mismatches in kidney transplant recipients

Individualized immunosuppression adjustment and kidney allocation based on specific HLA-DQ mismatch based on specific HLA-DQ mismatch may enhance long-term graft survival.

Donor specific HLA antibody in hematopoietic stem cell transplantation: Implications for donor selection

It is found that there is a clear consensus that moderate strength DSA should be avoided, while desensitization strategies are reported to be effective in most cases at reducing DSA to amenable levels.

Pediatric Kidney Transplantation—Can We Do Better? The Promise and Limitations of Epitope/Eplet Matching

A review of the current strengths and limitations of epitope matching software, the evidence for and against improved outcomes with epitope matched, discussion of eplet load vs. variable immunogenicity, and a discussion of the delicate balance of improving matching without disadvantaging certain populations are described.

Eplet mismatch imputation studies should include immunologic risk assessment

HLA eplet mismatch analysis represents the evolution from antigen-level match assessments and cell-based donor-specific antibody (DSA) identification to an integrated approach combining sophisticated…

Molecular disparity of HLA‐DPB1 is associated with the development of subsequent solid cancer after allogeneic hematopoietic stem cell transplantation

It was recently reported that HLA‐DPB1 alloimmunity determined by high mismatched eplets (MEs) and Predicted Indirectly Recognizable HLA Epitopes (PIRCHE) score (PS), was associated with relapse protection and increased risk of acute graft‐versus‐host disease (GVHD).

Combined Analysis of HLA Class II Eplet Mismatch and Tacrolimus Levels for the Prediction of De Novo Donor Specific Antibody Development in Kidney Transplant Recipients

The determination of HLA class II eplet mismatch may improve the risk stratification for dnDSA development, especially in conjunction with tacrolimus trough levels.

55 References

HLA‐DR/DQ molecular mismatch: A prognostic biomarker for primary alloimmunity

HLA‐DR/DQ single molecule eplet mismatch may represent a precise, reproducible, and widely available prognostic biomarker that can be applied to tailor immunosuppression or design clinical trials based on individual patient risk.

A Comparison of HLA Molecular Mismatch Methods to Determine HLA Immunogenicity

HLA molecular mismatch represents a precise method of alloimmune risk assessment for renal transplant patients and is likely to be driven by familiarity and ease of use as highly correlated results are produced by each method.

Alloantibody Responses After Renal Transplant Failure Can Be Better Predicted by Donor–Recipient HLA Amino Acid Sequence and Physicochemical Disparities Than Conventional HLA Matching

Differences in donor–recipient HLA amino‐acid sequence and physicochemical properties enable better assessment of the risk of HLA‐specific sensitization than conventional HLA matching.

The Synergistic Effect of Class II HLA Epitope‐Mismatch and Nonadherence on Acute Rejection and Graft Survival

Subclinical nonadherence early posttransplant combined with HLA class II epitope mismatch may help identify recipients that could benefit from increased clinical, histologic, and serologic monitoring.

OriginalClinicalScienceçGeneral The Risk of Transplant Failure With HLA Mismatch in First Adult Kidney Allografts From Deceased Donors

A significant linear relationship of hazard ratios was associated with HLAmismatch and affects allograft survival even during the recent periods of increasing success in renal transplantation.

PIRCHE-II Is Related to Graft Failure after Kidney Transplantation

The possible association between PIRCHE-II and kidney graft failure in 2,918 donor–recipients couples that were transplanted between 1995 and 2005 and inclusion in donor-selection criteria may eventually lead to an improved kidney graft survival are suggested.

Application of an epitope‐based allocation system in pediatric kidney transplantation

Epitope‐based allocation achieved timely access to transplantation, low class II eplet mismatches, and low rates of dnDSAs in the first year, and has the potential to reduce anti‐HLA sensitization and improve both graft survival and opportunities for future retransplantation.

Antibody-Mediated Rejection: Analyzing the Risk, Proposing Solutions

The use of HLA matching as a means of allocating kidneys and improving renal transplantation outcomes has not always received universal support, and failure of poorly matched grafts did not result in increased rates of sensitization, which questions once more the need of emphasizing HLA matched before transplantation.

Class II Eplet Mismatch Modulates Tacrolimus Trough Levels Required to Prevent Donor-Specific Antibody Development.

Recipients with high HLA alloimmune risk should not target tacrolimus levels <5 ng/ml unless essential, and monitoring for dnDSA may be advisable in this setting, as HLA-DR/DQ eplet mismatch and tacro Limus trough levels are independent predictors of dNDSA development.

Frequency and clinical implications of development of donor-specific and non-donor-specific HLA antibodies after kidney transplantation.

Screening of HLA antibodies posttransplantation could be a good tool for the follow-up of patients who receive a kidney transplant and allow immunosuppression to be tailored.
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