title: Human leukocyte antigens and alloimmunization in heart transplantation: an open debate.
abstract: Considerable advances in heart transplantation outcome have been achieved through the improvement of donor-recipient selection, better organ preservation, lower rates of perioperative mortality and the use of innovative immunosuppressive protocols. Nevertheless, long-term survival is still influenced by late complications. We support the introduction of HLA matching as an additional criterion in the heart allocation. Indeed, allosensitization is an important factor affecting heart transplantation and the presence of anti-HLA antibodies causes an increased risk of antibody-mediated rejection and graft failure. On the other hand, the rate of heart-immunized patients awaiting transplantation is steadily increasing due to the limited availability of organs and an increased use of ventricular assist devices. Significant benefits may result from virtual crossmatch approach that prevents transplantation in the presence of unacceptable donor antigens. A combination of both virtual crossmatch and a tailored desensitization therapy could be a good compromise for a favorable outcome in highly sensitized patients. Here, we discuss the unresolved issue on the clinical immunology of heart transplantation.
authors.affiliation: U.O.C. Division of Immunohematology, Transfusion Medicine and Transplant Immunology [SIMT], Regional Reference Laboratory of Transplant Immunology [LIT], Azienda Ospedaliera Universitaria (AOU), Second University of Naples, Piazza L. Miraglia 2, 80138, Naples, Italy, antonietta.picascia@policliniconapoli.it.
authors.forename: Antonietta
authors.initials: A
authors.lastname: Picascia
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Grimaldi
authors.forename: Amelia
authors.initials: A
authors.lastname: Casamassimi
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: De Pascale
authors.forename: Concetta
authors.initials: C
authors.lastname: Schiano
authors.forename: Claudio
authors.initials: C
authors.lastname: Napoli
mesh_terms: D006084:Graft Rejection / Q000276:immunology* / Q000401:mortality / Q000517:prevention & control; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood*; D011237:Predictive Value of Tests; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies