Department of Medicine, University of Manitoba.
Shared Health Services Manitoba.
Curr Opin Nephrol Hypertens. 2020 Nov;29(6):630-635. doi: 10.1097/MNH.0000000000000649.
A precise understanding of the alloimmune risk faced by individual recipients at the time of transplant is an unmet need in transplantation. Although conventional HLA donor-recipient mismatch is too imprecise to fulfil this need, HLA molecular mismatch increases the precision in alloimmune risk assessment by quantifying the difference between donors and recipients at the molecular level.
Within each conventional HLA mismatch the number, type, and position of mismatched amino acids create a wide range of HLA molecular mismatches between recipients and donors. Multiple different solid organ transplant groups from across the world have correlated HLA molecular mismatch with transplant outcomes including de novo donor-specific antibody development, antibody-mediated rejection, T-cell-mediated rejection, and allograft survival.
All alloimmunity is driven by differences between donors and recipients at the molecular level. HLA molecular mismatch may represent an advancement compared to traditional HLA antigen mismatch as a fast, reproducible, cost-effective way to improve alloimmune risk assessment at the time of transplantation to move the field towards precision medicine.
在移植时准确了解个体受者所面临的同种异体免疫风险是移植领域尚未满足的需求。尽管传统 HLA 供受者错配过于不精确，无法满足这一需求，但 HLA 分子错配通过量化供者和受者之间在分子水平上的差异，提高了同种异体免疫风险评估的精确性。
在每个传统 HLA 错配中，错配氨基酸的数量、类型和位置在受者和供者之间造成了广泛的 HLA 分子错配。来自世界各地的多个不同实体器官移植组已经将 HLA 分子错配与移植结果相关联，包括新出现的供者特异性抗体的产生、抗体介导的排斥反应、T 细胞介导的排斥反应和移植物存活。
所有同种异体免疫都是由供者和受者在分子水平上的差异驱动的。与传统的 HLA 抗原错配相比，HLA 分子错配可能是一种进步，因为它是一种快速、可重复、具有成本效益的方法，可以改善移植时的同种异体免疫风险评估，使该领域朝着精准医学的方向发展。
