Should We Revisit HLA Matching to Improve Long-Term Graft Outcomes?
Purpose of Review
We present here an overview of the needs and requirements for human leukocyte antigen (HLA) matching, explain and explore the potential benefits of epitope matching, and discuss the benefits of allele-level high-resolution matching at all HLA loci, i.e. HLA-A, -B, -DR, -DQ and -DP, for donor selection needs during renal transplantation.
Donor recipient HLA matching has a substantial impact on organ transplantation by prolonging graft survival, minimizing rejection episodes, preventing sensitization, providing a better chance for retransplantation and reducing the percentage of deaths due to graft dysfunction. Despite these advantages, the utility of HLA matching has been challenged, mainly because of the availability of highly effective immunosuppressive agents clubbed with steady improvements in short-term graft survival. Moreover, the risk associated with prolonged periods on dialysis while waiting for an optimally matched donor is minimized.
There is a need to strike a balance between the benefits of HLA matching and problems associated with finding such a donor. A more viable alternative would be to find a donor with mismatches having a low probability of inducing humoral responses.
KeywordsHLA matching Epitopes Graft outcome Donor-specific antibodies
Compliance with Ethical Standards
Conflict of Interest
Ajay Kumar Baranwal, Yoginder Pal Singh, and Narinder Mehra declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human participants or animals performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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