Differential immunogenicity of HLA mismatches in clinical transplantation.
Although HLA matching is beneficial in clinical transplantation, it is not feasible to select a completely HLA matched donor for every potential recipient because of the enormous polymorphism of the HLA system. As a consequence, the majority of the recipients will be transplanted with a mismatched donor organ or hematopoietic stem cell transplant. For this large group of patients it is important to take advantage of the differential immunogenicity of HLA mismatches and to select for them a donor with HLA mismatches of low immunogenicity, the so-called acceptable mismatches. The differential immunogenicity of HLA mismatches can be determined by either retrospective analysis of graft survival data or by in vitro assays measuring T-cell and B-cell alloreactivity. A recently developed computer algorithm (HLAMatchmaker) can be instrumental in selecting donors with HLA mismatches, which do not lead to alloantibody formation. The theoretical background and practical implications of this acceptable mismatch approach are discussed.
Leiden University Medical Center, Leiden, The Netherlands. fhjclaas@lumc.nl
Frans H J
FH
Claas
Marlies K
MK
Dankers
Machteld
M
Oudshoorn
Jon J
JJ
van Rood
Arend
A
Mulder
Dave L
DL
Roelen
Rene J
RJ
Duquesnoy
Ilias I N
II
Doxiadis
D000465:Algorithms; D000818:Animals; D046148:Donor Selection / Q000379:methods*; D006085:Graft Survival / Q000235:genetics / Q000276:immunology; D006680:HLA Antigens / Q000235:genetics* / Q000276:immunology; D006648:Histocompatibility; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D011110:Polymorphism, Genetic; D012984:Software
D006680:HLA Antigens