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Personalized Peptide Arrays for Detection of HLA Alloantibodies in Organ Transplantation
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Human leukocyte antigens and alloimmunization in heart transplantation: an open debate

Antonietta Picascia1, Vincenzo Grimaldi, Amelia Casamassimi

  • 1U.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.

Journal of Cardiovascular Translational Research
|September 6, 2014
PubMed

Insights

Human leukocyte antigen (HLA) matching can improve heart transplant outcomes by reducing antibody-mediated rejection. Virtual crossmatch and desensitization therapy offer benefits for highly sensitized patients awaiting transplants.

Area of Science:

  • Immunology
  • Transplantation Science
  • Cardiology

Background:

  • Heart transplantation outcomes have improved due to better donor selection, organ preservation, and immunosuppression.
  • Long-term graft survival remains challenged by late complications, particularly in sensitized patients.
  • Increasing rates of sensitized patients awaiting heart transplants are linked to organ scarcity and ventricular assist device use.

Purpose of the Study:

  • To advocate for human leukocyte antigen (HLA) matching as an additional criterion in heart allocation.
  • To highlight the role of allosensitization and anti-HLA antibodies in heart transplant rejection and graft failure.
  • To discuss the potential benefits of virtual crossmatch and desensitization protocols for highly sensitized recipients.

Main Methods:

  • Review of current practices and challenges in heart transplantation immunology.
  • Analysis of the impact of HLA antibodies on graft outcomes.
  • Discussion of virtual crossmatch and desensitization strategies.

Main Results:

  • Allosensitization and anti-HLA antibodies significantly increase the risk of antibody-mediated rejection and graft failure.
  • Virtual crossmatch can prevent transplantation with unacceptable donor antigens.
  • Combining virtual crossmatch with tailored desensitization may improve outcomes for highly sensitized patients.

Conclusions:

  • Introduction of HLA matching in heart allocation is supported to enhance long-term survival.
  • Virtual crossmatch and desensitization therapy represent a promising approach for managing highly sensitized heart transplant candidates.
  • Further research into the clinical immunology of heart transplantation is needed to address unresolved issues.

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