Bezstarosti Suzanne, Heidt Sebastiaan
Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands.
Transpl Int. 2025 Aug 13;38:14716. doi: 10.3389/ti.2025.14716. eCollection 2025.
HLA molecular matching in solid organ transplantation in the form of eplets, solvent-accessible amino acids or PIRCHE-II has been proposed as a more granular method than HLA matching on the antigen level. While many studies have shown the association between molecular mismatches and donor-specific antibody formation, rejection and graft loss, evidence for prospective molecular matching in allocation is currently lacking, and the actual practical implementation and feasibility of molecular matching remains unclear. In this review the various potential applications of molecular matching in transplantation are discussed, including 1) organ allocation in deceased donor programs, 2) living donor selection, 3) increasing the transplantability of highly sensitized patients and 4) risk stratification to facilitate personalized immunosuppressive management, along with the challenges and gaps in current knowledge regarding these approaches. While clinical application of molecular mismatch analysis in solid organ transplantation holds promise, the fundamentals of HLA-specific antibody biology and epitope-paratope interactions should be further elucidated. This will aid in unraveling the factors that affect the relative immunogenicity of HLA molecular mismatches in order to start using molecular matching in clinical transplantation.
以表位、溶剂可及氨基酸或PIRCHE-II形式进行的实体器官移植中的HLA分子匹配,已被提议作为一种比抗原水平的HLA匹配更精细的方法。虽然许多研究表明分子错配与供体特异性抗体形成、排斥反应和移植物丢失之间存在关联,但目前缺乏在分配中进行前瞻性分子匹配的证据,而且分子匹配的实际实施和可行性仍不明确。在这篇综述中,讨论了分子匹配在移植中的各种潜在应用,包括1) deceased donor计划中的器官分配,2)活体供体选择,3)提高高度致敏患者的移植可能性,以及4)进行风险分层以促进个性化免疫抑制管理,同时也讨论了关于这些方法的当前知识中的挑战和差距。虽然实体器官移植中分子错配分析的临床应用前景广阔,但HLA特异性抗体生物学和表位-互补位相互作用的基本原理仍需进一步阐明。这将有助于揭示影响HLA分子错配相对免疫原性的因素,以便开始在临床移植中使用分子匹配。