Institute of Immunology, Heidelberg University Hospital, Heidelberg, Germany.
Institute for Transfusion Medicine, Essen University Hospital, Essen, Germany.
Best Pract Res Clin Haematol. 2024 Sep;37(3):101576. doi: 10.1016/j.beha.2024.101576. Epub 2024 Aug 28.
Advances in hematopoietic cell transplantation have expanded the use of alternative donors such as haploidentical family donors or mismatched unrelated donors. However, donor-specific HLA antibodies (DSA) have been recognized as a significant risk factor of primary graft failure after HLA incompatible transplantation. Therefore, screening for HLA antibodies and taking DSA into consideration in the process of donor search play an increasingly important role in donor selection. If an HLA compatible donor is not available, desensitization may enable a successful transplantation. In this review, we describe the currently most widely used methods for HLA antibody detections including their pitfalls. In addition, we summarize the results of the studies on the impact of preformed DSA on transplant outcomes and their treatment options. Many more and larger studies are needed to clarify laboratory issues as well as immunological and clinical aspects in the management of DSA.
造血细胞移植的进展扩大了替代供者的应用范围，如半相合家族供者或不合配的无关供者。然而，供者特异性 HLA 抗体（DSA）已被认为是 HLA 不相容移植后原发性移植物失败的一个重要危险因素。因此，在供者搜索过程中筛查 HLA 抗体并考虑 DSA 在供者选择中起着越来越重要的作用。如果没有 HLA 相容的供者，脱敏可能使移植成功。在这篇综述中，我们描述了目前最广泛使用的 HLA 抗体检测方法，包括它们的缺陷。此外，我们总结了关于预先形成的 DSA 对移植结果的影响及其治疗选择的研究结果。需要进行更多和更大的研究，以阐明实验室问题以及 DSA 管理中的免疫和临床方面。
