Clinical significance of HLA antigens and non-HLA antigens in solid organ transplantation

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Abstract

Purpose of Review

We will describe the role of HLA antigens in solid organ transplant survival. In addition, non-HLA antigens, such as major histocompatibility complex class I-related chain A, endothelial antigens, vimentin and others will be described and correlated to allograft outcome.

Recent Findings

HLA antigens play a central role in the cellular and humoral immune responses that determine transplant outcome. Matching donor and recipient HLA antigens has historically resulted in better transplant outcomes. The use of biologics and newer immunosuppressive drugs, however, has resulted in improved transplant outcomes and, at the same time, also has resulted in a declining importance and need for HLA antigen matching. There are also data suggesting that long-term graft loss to chronic allograft nephropathy involves different immune and nonimmune mechanisms than those that cause early graft loss. These data have allowed for the consideration that antigen systems other than HLA antigens may play a role in long-term transplant outcome.

Summary

While the relevance of HLA antigen matching is in decline, the presence of antibodies to target HLA antigens before and after transplantation has been significantly correlated with early rejection and poor graft outcome. Little is known about these newly identified non-HLA antigens and if antibodies directed against them play a significant role in graft outcome.

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