title: Clinical relevance of human leukocyte antigen antibodies in liver, heart, lung and intestine transplantation.
abstract: OBJECTIVE
  Solid phase assays identify human leukocyte antigen (HLA) antibodies with a great sensitivity. Whether to accept or decline an organ if the virtual crossmatch is positive, when to monitor and whether to treat de-novo donor-specific antibody (DSA) posttransplant remain challenging issues for the transplant clinician.
  
  
  RESULTS
  Technologies that can differentiate which antibodies pose the greatest risk for antibody-mediated rejection (AMR) are evolving. Complement fixing luminex assays have been used to predict high-risk antibodies, but using these assays alone will miss some preformed antibodies. How these technologies fit into the laboratory's testing algorithm will likely need to be individualized. Posttransplant de-novo DSAs are associated with inferior outcomes. In hearts, similar to renal transplantation, acute rejection is a risk factor for developing de-novo DSA. Further data are needed to determine whether other risk factors are similar to those reported for renal transplants. Antibodies to self-antigens are increasingly recognized posttransplant and how the alloimmune response contributes to altered autoregulation is a current research focus.
  
  
  CONCLUSIONS
  Identification of DSA enables the clinician to make informed decisions regarding whether or not to accept an organ and if augmented immunosuppression is indicated. Monitoring for DSA posttransplant identifies recipients at a greater risk for AMR and can guide management. However, the best approach to dealing with de-novo DSA remains unclear.
authors.affiliation: Department of Medicine and Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada. trish.campbell@ualberta.ca
authors.forename: Patricia
authors.initials: P
authors.lastname: Campbell
mesh_terms: D015415:Biomarkers; D006680:HLA Antigens / Q000276:immunology*; D016027:Heart Transplantation / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D007518:Isoantibodies / Q000097:blood*; D016031:Liver Transplantation / Q000276:immunology*; D016040:Lung Transplantation / Q000276:immunology*; D014019:Tissue Donors
chemical_list: D015415:Biomarkers; D006680:HLA Antigens; D007518:Isoantibodies