PMID- 31135563
OWN - NLM
STAT- MEDLINE
DCOM- 20200408
LR  - 20200408
IS  - 1531-7013 (Electronic)
IS  - 1087-2418 (Linking)
VI  - 24
IP  - 4
DP  - 2019 Aug
TI  - Epitope matching in kidney transplantation: recent advances and current 
      limitations.
PG  - 370-377
LID - 10.1097/MOT.0000000000000657 [doi]
AB  - PURPOSE OF REVIEW: Evolution of human leukocyte antigen (HLA) molecular typing 
      techniques has progressively enabled more accurate determination of the 
      three-dimensional building blocks that form the antibody accessibility and 
      binding sites of each HLA allele. These immunogenic HLA regions known as epitopes 
      are composed of polymorphic sequences of amino acid residues termed eplets. This 
      review provides a critical appraisal of the current understanding of epitope 
      compatibility in kidney transplantation. RECENT FINDINGS: There is a tendency to 
      suggest that epitope matching is likely to be superior to broad antigen HLA 
      matching such that the allocation of donor kidneys to patients with a more 
      favorable epitope compatibility profile may lead to better allograft outcomes. A 
      growing body of work has highlighted the association between a greater number of 
      eplet mismatches and adverse allograft outcomes, and approaches using eplet 
      matching have been successfully implemented in organ allocation programs. 
      However, our understanding of epitope compatibility remains in its infancy, 
      requiring further and more in-depth evaluation. Critically, it remains unclear 
      how best to translate findings derived at the population level to the care of 
      individual patients. Questions that need to be answered include a lack of 
      consensus in the definition and interpretation of epitope compatibility, are 
      class I and II compatibility of similar clinical importance, how best to define 
      predetermined mismatch thresholds for utilization in organ allocation, and 
      whether other properties such as differences in electrostatic potential between 
      donor and recipient HLA alleles are also important in determining immunological 
      compatibility. SUMMARY: Epitope matching likely represents a valid progression in 
      understanding donor-recipient HLA compatibility. However, more clinical data and 
      a better understanding about differences in methods to determine epitope 
      compatibility are required before the approach can be widely applied in clinical 
      practice.
FAU - Larkins, Nicholas G
AU  - Larkins NG
AD  - Department of Nephrology, Perth Children's Hospital.
AD  - School of Paediatrics and Child Health.
FAU - Wong, Germaine
AU  - Wong G
AD  - Sydney School of Public Health, University of Sydney.
AD  - Centre for Kidney Research, The Children's Hospital at Westmead and the Centre 
      for Transplant and Renal Research.
FAU - Taverniti, Anne
AU  - Taverniti A
AD  - New South Wales Transplantation & Immunogenetics Services, Australian Red Cross 
      Blood Service, Sydney, Australia.
FAU - Lim, Wai H
AU  - Lim WH
AD  - School of Medicine, University of Western Australia.
AD  - Department of Renal Medicine, Sir Charles Gardiner Hospital, Perth.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Curr Opin Organ Transplant
JT  - Current opinion in organ transplantation
JID - 9717388
RN  - 0 (Epitopes)
SB  - IM
MH  - Epitopes/*immunology
MH  - Histocompatibility Testing/*methods
MH  - Humans
MH  - Kidney Transplantation/*methods
EDAT- 2019/05/29 06:00
MHDA- 2020/04/09 06:00
CRDT- 2019/05/29 06:00
PHST- 2019/05/29 06:00 [pubmed]
PHST- 2020/04/09 06:00 [medline]
PHST- 2019/05/29 06:00 [entrez]
AID - 10.1097/MOT.0000000000000657 [doi]
PST - ppublish
SO  - Curr Opin Organ Transplant. 2019 Aug;24(4):370-377. doi: 
      10.1097/MOT.0000000000000657.