Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia.
Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead and the Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia.
Kidney Int. 2018 Feb;93(2):314-324. doi: 10.1016/j.kint.2017.08.008. Epub 2017 Oct 20.
This review describes the recent developments in the applicability and clinical significance of epitope matching in kidney transplantation. As incremental human leukocyte antigen (HLA) mismatches are associated with increased risk of rejection and allograft loss, HLA-matching remains one of the standard immunological triage tests to determine transplant suitability. Advancements in tissue-typing techniques have led to innovative concepts of HLA-matching at the epitope level. Epitopes are configurations of polymorphic amino acid residues that are recognized by B cells, and antibodies reactive with these epitopes lead to rejection and/or premature allograft loss. Even though there is substantial advancement in the characterization and understanding of epitopes, evidence supporting the added clinical benefit of epitope matching over traditional antigen matching and the ability to identify clinically relevant immunogenic epitopes remains poorly defined. We present an overview of the evidence surrounding the immunogenicity of mismatched donor epitopes and the applicability of HLA epitope matching in kidney transplantation. A better understanding of the immunogenicity and structural characteristics of HLA epitopes will guide clinicians to integrate epitope matching as an important parameter for donor selection in kidney transplantation.
本文综述了抗原匹配在肾移植中的应用和临床意义的最新进展。由于递增的人类白细胞抗原（HLA）错配与排斥反应和移植物丢失的风险增加相关，HLA 匹配仍然是确定移植适用性的标准免疫分类测试之一。组织分型技术的进步带来了 HLA 表位水平匹配的创新概念。表位是由 B 细胞识别的多态性氨基酸残基的构型，与这些表位反应的抗体导致排斥和/或移植物提前丢失。尽管在表位的特征描述和理解方面取得了实质性进展，但支持表位匹配优于传统抗原匹配的附加临床益处的证据以及识别临床相关免疫原性表位的能力仍然定义不明确。我们介绍了围绕供体错配表位的免疫原性和 HLA 表位匹配在肾移植中的适用性的证据概述。更好地了解 HLA 表位的免疫原性和结构特征将指导临床医生将表位匹配整合为肾移植中供体选择的重要参数。
