Niemann Matthias, Matern Benedict M
PIRCHE AG.
Charité - Universitätsmedizin Berlin, Berlin, Germany.
Curr Opin Organ Transplant. 2025 Feb 1;30(1):30-36. doi: 10.1097/MOT.0000000000001185. Epub 2024 Nov 12.
Molecular matching continues to be an important topic in organ transplantation. Over the years, several studies - larger and smaller - supported correlations of molecular incompatibility loads and clinical outcomes. However, their practical utility for clinical decision making remains controversial and there is no consensus on the context in which they should be used.
The recent literature on molecular matching can be divided into four main areas of research: several groups present improvements of the algorithmic pipelines (1), increasing the robustness of previous findings. Further clinical evidence is reported (2) in various cohorts and other organ transplant domains, such as liver and lung transplantation. Consideration is given to the application of molecular matching in the allocation of deceased organs (3), suggesting options to improve allocation equity and utility. Furthermore, evidence is provided for personalized immunosuppression based on immunological risk (4), including infection and post graft failure management.
There is ample evidence that current molecular matching algorithms add value to immunologic risk stratification for organ transplant recipients. First studies on how to translate these insights into patient management with respect to organ allocation and personalized medicine are underway and require further support.
分子匹配仍是器官移植领域的重要课题。多年来，多项规模或大或小的研究支持分子不相容负荷与临床结局之间存在关联。然而，其在临床决策中的实际效用仍存在争议，对于应在何种情况下使用它们也未达成共识。
近期关于分子匹配的文献可分为四个主要研究领域：多个研究团队对算法流程进行了改进（1），增强了以往研究结果的稳健性。在不同队列以及肝脏和肺移植等其他器官移植领域报告了更多临床证据（2）。探讨了分子匹配在 deceased 器官分配中的应用（3），提出了改善分配公平性和效用的方案。此外，还提供了基于免疫风险的个性化免疫抑制的证据（4），包括感染和移植后失败管理。
有充分证据表明，当前的分子匹配算法可为器官移植受者的免疫风险分层增添价值。关于如何将这些见解转化为器官分配和个性化医疗方面的患者管理的初步研究正在进行中，且需要进一步支持。
