The evolution of hlamatching in kidney transplantation. Kidney transplantation remains the treatment of choice for endstage renal failure. Hla matching improves kidney, heart, and lung graft survival, but an hlabased abo, hla, lymphocytotoxicity crossmatch donor organ allocation has. An overview for the general nephrologist article in american journal of kidney diseases 715 december 2017 with 59 reads how we measure reads. A major stimulant of allograft rejection is recipient t cell recognition of human leukocyte antigens hla in the donor kidney. Hla class i hla a, hla b and hla c antigens and hla class ii hla dp, hla dq and hla dr antigens are molecules encoded by genes in the major histocompatibility complex and play a key role in. In renal transplant candidates, what hla antigens and nonhla.
But the latest european renal best practice transplantation guidelines still recommended that matching of hlaa, b, and dr whenever. Analysis of hla matching 20 years ago, when only 11 antigen. In this chapter, we will explore the effect of human leukocyte antigen hla matching on renal transplant outcomes. In the early days of renal transplantation, hla matching was introduced as a useful tool to improve graft survival. The major histocompatibility complex mhc was discovered and so. A microcomputer program was developed for selection of hla matched recipients in renal transplantation. Utility of hla antibody testing in kidney transplantation. As part of the host immune defense mechanism, human leukocyte antigen. Detection of hlaantibodies prior to renal transplantation. With the introduction of more potent immunosuppressive drugs, the difference in survival between well. Is matching for human leukocyte antigendr beneficial in. The human major histocompatibility complex is a family of genes that encodes hlas, which have a crucial role in defence against foreign pathogens and immune surveillance of. Hla matching between potential donors and transplant candidates is determined. Hla incompatible kidney transplantation this leaflet explains more about human leukocyte antigen hla incompatible transplantation sometimes called tissue type incompatible transplantation.
In a renal transplant recipient, how should hla matching be used to optimize outcome. Hla antigens are the primary alloantigens recognized by a host immune system in abo blood groupcompatible organ transplantation. Human leukocyte antigen hla sensitization is a major public health problem that limits access to renal transplantation for 30\% of the patients awaiting a kidney transplant. The competing goals of justice and optimal outcome in the allocation of. This practice point commentary discusses the findings and limitations of a report by gritsch et al. Erbp guideline on kidney donor and recipient evaluation and. It is based on hla compatibilities instead of mismatches, and ranks the quality of a dr match above a b match and an a match.
Determining the tissue type human leukocyte antigens. Does hla matching matter in the modern era of renal transplantation. Hla system hla typing and its role in tissue transplantation presenter. Cregs share one or more epitopes and immunisation against an hla antigen often results in antibodies that bind not only to the immunising antigens, but also to. What is the impact of human leukocyte antigen mismatching on graft. Thus, for noncaucasian recipients, implementation of creg matching could lead to an increase in the number of 6antigen matched transplants from 4 up to 30. Hla matching for kidney transplantation request pdf. When the immune system of the recipient recognizes the transplanted kidney as a foreign object, graft rejection occurs. Hla incompatible renal transplantation johns hopkins. As part of the host immune defense mechanism, human leukocyte antigen hla is a major challenge for graft rejection in transplantation therapy. Nationwide organ sharing using hla typing kidney international.
The importance of hla matching has been clearly established in renal transplantation and the extent of hla mismatches at the a, b and dr loci form an important. The first successful kidney transplant was performed in 1954 and was. However, the role of hla matching in kidney transplantation has long been a controversial topic. In transplantation, the more closely the donor and the recipient alleles matched, the. Current role of human leukocyte antigen matching in kidney transplantation. Human leukocyte antigens matching has been at the forefront of. Donorrecipient human leukocyte antigen hla matching improves outcomes after solidorgan transplantation, but current assessment of hla incompatibility is. Toward hla epitope matching in clinical transplantation. The evolution of hlamatching in kidney transplantation intechopen. The degree to which hla matching should be prioritized in allocating deceased donor kidneys, on the other hand, has been a subject of debate throughout the history of renal transplantation and in recent years, emphasis on matching donors and recipients for the hla a, b, and dr antigens has declined as the authors point out. This leaflet includes information on the benefits, risks and alternatives, and what you can expect when you come to hospital. In the united states, molecular typing results are submitted as a pdf.
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