The Evolution of HLA-Matching in Kidney Transplantation

In this chapter, we will explore the effect of human leukocyte antigen (HLA) matching on renal transplant outcomes. 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 part in the assessment of the immunological risk of potential transplant candidates. Increasing number of HLA mismatches has been shown to be associated with poorer graft and patient survival following kidney transplantation but the ongoing importance of this association in the era of more potent immunosuppression and improved donor selection remains unclear. Nevertheless, HLA mismatches remain a crucial component of deceased donor kidney allocation in most countries including the United States and Australia. As a result of major advances in technology, HLA-typing has evolved from serological-based typing to molecular HLA-typing and solid-phase anti-HLA-antibody-detection assays, which have had a major influence in both allocation and outcome of transplanted kidneys. The identification of donorspecific anti-HLA-antibody (DSA) has become standard practice and cross-matching assays to establish the presence of DSA has evolved from complement-dependent cytotoxicity (CDC) assay to the exquisitely sensitive flow-cytometric and solid-phase assays. The availability of these sensitive assays has enable clinicians to perform calculated panel reactive antibody and virtual cross-match, which has led to a more accurate assessment of immunological risk of potential transplant candidates and improvement in the allocation of deceased donor kidneys. Defining the appropriate threshold values for clinically relevant DSA assignment, the ongoing significance of HLA-matching in the presence of DSA and the importance of anti-HLA-Cw, HLA-DQ and HLA-DP antibodies remain poorly defined. Finally, we will discuss the process of identifying acceptable HLA-mismatches using HLAMatchmaker, which determines HLA-

• Publication year

  2013

• Venue

  Unknown venue

• Publication date

  2013-02-13

• Fields of study

  Medicine

• Identifiers
  DOI 10.5772/54747
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar

• No claims are published for this paper.

• No concepts are published for this paper.

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