title: From Humoral Theory to Performant Risk Stratification in Kidney Transplantation.
abstract: The purpose of the present review is to describe how we improve the model for risk stratification of transplant outcomes in kidney transplantation by incorporating the novel insights of donor-specific anti-HLA antibody (DSA) characteristics. The detection of anti-HLA DSA is widely used for the assessment of pre- and posttransplant risks of rejection and allograft loss; however, not all anti-HLA DSA carry the same risk for transplant outcomes. These antibodies have been shown to cause a wide spectrum of effects on allografts, ranging from the absence of injury to indolent or full-blown acute antibody-mediated rejection. Consequently, the presence of circulating anti-HLA DSA does not provide a sufficient level of accuracy for the risk stratification of allograft outcomes. Enhancing the predictive performance of anti-HLA DSA is currently one of the most pressing unmet needs for facilitating individualized treatment choices that may improve outcomes. Recent advancements in the assessment of anti-HLA DSA properties, including their strength, complement-binding capacity, and IgG subclass composition, significantly improved the risk stratification model to predict allograft injury and failure. Although risk stratification based on anti-HLA DSA properties appears promising, further specific studies that address immunological risk stratification in large and unselected populations are required to define the benefits and cost-effectiveness of such comprehensive assessment prior to clinical implementation.
authors.affiliation: Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, France; Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: C
authors.identifier: 0000-0002-6244-0795
authors.initials: C
authors.lastname: Lefaucheur
authors.affiliation: Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, France; Kidney Transplant Department, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Viglietti
authors.affiliation: Department of Transplant Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Mangiola
authors.affiliation: Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, France; Kidney Transplant Department, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Loupy
authors.affiliation: Department of Transplant Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Zeevi
mesh_terms: D064591:Allografts / Q000276:immunology*; D000918:Antibody Specificity; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000517:prevention & control; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D012307:Risk Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies