Khalil Muhammad Abdul Mabood, Sadagah Nihal Mohammed, Hediki Ishida, Tan Jackson, Al-Qurashi Salem H
Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital Jeddah, Jeddah 23311, Saudi Arabia.
Department of Urology and Transplantation, Tokyo Women's Medical University Hospital, Tokyo 162-8666, Japan.
World J Transplant. 2025 Jun 18;15(2):99952. doi: 10.5500/wjt.v15.i2.99952.
HLA-C, HLA-DP and HLA-DQ are thought to be benign due to low expression and few initial negative studies. Historically, most allocation programs used HLA-A, HLA-B and HLA-DR antigens for matching. With the advent and use of single-bead antigen assays, more was learned about donor-specific antibodies (DSAs) against these antigens. Interest in these antigens and antibodies grew when cases of acute antibody-mediated rejection (AMR), mixed rejections, chronic AMR, and reduced graft survival were reported with DSAs against these antigens. Although the deleterious effects of these DSAs are more pronounced in retransplants, harmful effects have also been observed in first-time recipients. DSAs against each of these antigens can trigger rejection alone. Their combination with DSAs against HLA-A, HLA-B and HLA-DR can cause more damage. It has been shown that strategies that reduce mismatches for these antigen lead to fewer rejections and better graft survival. There is a need for greater consensus on the universal typing of these antigens prior to transplantation for better patient and graft outcomes. This review focuses on the interaction of these antigens with lymphocytes and killer immunoglobulin receptors, arguments for not typing them, detailed analyses of the literature about their harmful effects, potential strategies moving forward, and recommendations for the future.
由于表达水平低且最初的阴性研究较少，HLA - C、HLA - DP和HLA - DQ被认为是良性的。从历史上看，大多数配型方案使用HLA - A、HLA - B和HLA - DR抗原进行配型。随着单珠抗原检测方法的出现和应用，人们对针对这些抗原的供体特异性抗体（DSA）有了更多了解。当报告了针对这些抗原的DSA导致急性抗体介导的排斥反应（AMR）、混合性排斥反应、慢性AMR以及移植肾存活期缩短的病例后，人们对这些抗原和抗体的关注度增加。尽管这些DSA的有害作用在再次移植中更为明显，但在初次接受者中也观察到了有害影响。针对这些抗原中的每一种的DSA都可单独引发排斥反应。它们与针对HLA - A、HLA - B和HLA - DR的DSA联合可造成更大损害。已表明减少这些抗原错配的策略可减少排斥反应并提高移植肾存活率。在移植前对这些抗原进行通用分型以获得更好的患者和移植肾结局方面，需要达成更大的共识。本综述重点关注这些抗原与淋巴细胞和杀伤性免疫球蛋白受体的相互作用、不进行分型的理由、关于其有害作用的文献详细分析、未来可能的策略以及对未来的建议。
