Some considerations on the current debate about typing resolution in solid organ transplantation

BackgroundThe shortage of suitable organs and achieved tolerance are uncontested main concerns in transplantation. Long waiting lists for deceased donors and limited numbers of living donors are the current scenarios. Kidney grafts from living donors have better overall survival compared to cadaveric and require less aggressive immunosuppressive regimens. The human leukocyte antigen (HLA) labs have the key role to test the recipient and donors compatibility based on typing and antibody profile. The current standard molecular procedure in solid organ transplantation is low-resolution typing, at the antigen level.Main textIn this commentary, the merits of high versus low degree of typing resolution in solid organ transplantation are discussed. Critical questions and reasons to bring high-resolution typing as a routine test in health system are considered. Specifically, with the introduction of the next-generation sequencing (NGS) in HLA, the pros and cons in living donation and benefits after deceased donation are critically evaluated.ConclusionNGS has the potential to improve the transplant rates and the overall graft survival. Alternative strategies to increase in demanding the number of transplants are briefly highlighted.

[1]  J. Friedewald,et al.  Should HLA Mismatch Acceptability for Sensitized Transplant Candidates Be Determined at the High‐Resolution Rather Than the Antigen Level? , 2015, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[2]  K. Kokko,et al.  Donor‐Directed MHC Class I Antibody Is Preferentially Cleared from Sensitized Recipients of Combined Liver/Kidney Transplants , 2011, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[3]  S. Chadban,et al.  The Expectations and Attitudes of Patients With Chronic Kidney Disease Toward Living Kidney Donor Transplantation: A Thematic Synthesis of Qualitative Studies , 2015, Transplantation.

[4]  Harriet Noreen,et al.  Common and well-documented HLA alleles: report of the Ad-Hoc committee of the american society for histocompatiblity and immunogenetics. , 2007, Human immunology.

[5]  A. Reed,et al.  AST/ASTS Workshop on Increasing Organ Donation in the United States: Creating an “Arc of Change” From Removing Disincentives to Testing Incentives , 2015, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[6]  E. Gordon,et al.  Consensus Conference on Best Practices in Live Kidney Donation: Recommendations to Optimize Education, Access, and Care , 2015, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[7]  N. Salomonis,et al.  The kSORT Assay to Detect Renal Transplant Patients at High Risk for Acute Rejection: Results of the Multicenter AART Study , 2014, PLoS medicine.

[8]  J. Boletis,et al.  Incidence and Clinical Significance of De Novo Donor Specific Antibodies after Kidney Transplantation , 2013, Clinical & developmental immunology.

[9]  Andrew R. Jones,et al.  16th IHIW: Extending the number of resources and bioinformatics analysis for the investigation of HLA rare alleles , 2012, International journal of immunogenetics.

[10]  A. Novick,et al.  Transplantation of pediatric en bloc cadaver kidneys into adult recipients. , 1998, Transplantation.

[11]  E. Reed,et al.  HLA High‐Resolution Typing for Sensitized Patients: A Solution in Search of a Problem? , 2015, American Journal of Transplantation.

[12]  Anita Landa,et al.  A thematic synthesis of qualitative studies about patients`perceptions of information and education given in relation to implantable cardioverter defibrillator (ICD) implantation , 2016 .

[13]  E. Benedetti,et al.  Robotic-assisted Kidney Transplantation: Our Experience and Literature Review , 2015, Current Transplantation Reports.

[14]  A. Papazoglou,et al.  Identification and characterization of a novel HLA-B hybrid allele, B*08:132 with Next Generation Sequencing. , 2014, Tissue antigens.

[15]  P. Nickerson,et al.  cPRA Increases With DQA, DPA, and DPB Unacceptable Antigens in the Canadian cPRA Calculator , 2015, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[16]  J. Platt,et al.  Donor-specific B-cell tolerance after ABO-incompatible infant heart transplantation , 2004, Nature Medicine.

[17]  P. Parham,et al.  16th IHIW : Review of HLA typing by NGS , 2013, International journal of immunogenetics.