HLA antibody profiling in thoracic transplantation undergoing desensitization therapy.
OBJECTIVE
Desensitization therapies in sensitized patients have been implemented to lower the human leukocyte antigen (HLA) antibody burden and facilitate thoracic transplantation. This review will focus on the characterization of HLA antibodies pre- and post-intervention, to assess the changes in antibody titer and function that might promote transplantation with low risk of early antibody-mediated rejection (AMR).


RESULTS
A steady increase in the proportion of both adult and pediatric sensitized thoracic patients awaiting transplantation has been observed over the last years. Patients with elevated panel reactive antibodies at the time of listing have a poorer outcome compared to nonsensitized patients. Advances in solid phase assays for HLA antibodies have benefited the detection accuracy and characterization of clinically relevant anti-HLA antibodies. Therefore, monitoring the level and function of HLA antibodies following desensitization protocols can be used to determine the success of achieving acceptable antibody levels for safe transplantation and also the risk of AMR.


CONCLUSIONS
Allosensitization among candidates considered for thoracic transplantation remains a great challenge. Determining the efficacy of desensitizing protocols by incorporating new tools for monitoring antibody profiles can better stratify a candidate's immunologic risk, thereby increasing the likelihood of transplantation and minimizing AMR.
Department of Pathology, Division of Transplant Pathology, University of Pittsburgh. Pittsburgh, Pennsylvania, USA. zeevia@upmc.edu
Adriana
A
Zeevi
John
J
Lunz
D000906:Antibodies / Q000097:blood / Q000276:immunology*; D015922:Complement C1q / Q000032:analysis / Q000276:immunology; D003888:Desensitization, Immunologic; D006084:Graft Rejection / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D016027:Heart Transplantation / Q000276:immunology*; D006801:Humans
D000906:Antibodies; D006680:HLA Antigens; D015922:Complement C1q