PMID- 34246656
OWN - NLM
STAT- MEDLINE
DCOM- 20211101
LR  - 20220531
IS  - 1523-1755 (Electronic)
IS  - 0085-2538 (Linking)
VI  - 100
IP  - 5
DP  - 2021 Nov
TI  - Significance of HLA-DQ in kidney transplantation: time to reevaluate human 
      leukocyte antigen-matching priorities to improve transplant outcomes? An expert 
      review and recommendations.
PG  - 1012-1022
LID - S0085-2538(21)00657-8 [pii]
LID - 10.1016/j.kint.2021.06.026 [doi]
AB  - The weight of human leukocyte antigen (HLA) matching in kidney allocation 
      algorithms, especially in the United States, has been devalued in a stepwise 
      manner, supported by the introduction of modern immunosuppression. The intent was 
      further to reduce the observed ethnic/racial disparity, as data emerged 
      associating HLA matching with decreased access to transplantation for African 
      American patients. In recent years, it has been increasingly recognized that a 
      leading cause of graft loss is chronic antibody-mediated rejection, attributed to 
      the development of de novo antibodies against mismatched donor HLA expressed on 
      the graft. These antibodies are most frequently against donor HLA-DQ molecules. 
      Beyond their impact on graft survival, generation of de novo donor-specific HLA 
      antibodies also leads to increased sensitization, as measured by panel-reactive 
      antibody metrics. Consequently, access to transplantation for patients returning 
      to the waitlist in need of a second transplant is compromised. Herein, we address 
      the implications of reduced HLA matching policies in kidney allocation. We 
      highlight the observed diminished outcome data, the significant financial burden, 
      the long-term health consequences, and, more important, the unintended 
      consequences. We further provide recommendations to examine the impact of 
      donor-recipient HLA class II and specifically HLA-DQalpha(1)beta(1) mismatching, 
      focusing on collection of appropriate data, application of creative simulation 
      approaches, and reconsideration of best practices to reduce inequalities while 
      optimizing patient outcomes.
CI  - Copyright (c) 2021 International Society of Nephrology. Published by Elsevier Inc. 
      All rights reserved.
FAU - Tambur, Anat R
AU  - Tambur AR
AD  - Department of Surgery, Comprehensive Transplant Center, Northwestern University, 
      Chicago, Illinois, USA. Electronic address: a-tambur@northwestern.edu.
FAU - Kosmoliaptsis, Vasilis
AU  - Kosmoliaptsis V
AD  - Department of Surgery, University of Cambridge, Cambridge, UK; National Institute 
      of Health Research (NIHR) Blood and Transplant Research Unit in Organ Donation 
      and Transplantation and NIHR Cambridge Biomedical Research Centre, University of 
      Cambridge, Cambridge, UK.
FAU - Claas, Frans H J
AU  - Claas FHJ
AD  - Department of Immunology, Leiden University Medical Center, Leiden, the 
      Netherlands.
FAU - Mannon, Roslyn B
AU  - Mannon RB
AD  - Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, 
      USA.
FAU - Nickerson, Peter
AU  - Nickerson P
AD  - Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
FAU - Naesens, Maarten
AU  - Naesens M
AD  - Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, 
      Belgium.
LA  - eng
GR  - PDF-2016-09-065/DH_/Department of Health/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20210708
PL  - United States
TA  - Kidney Int
JT  - Kidney international
JID - 0323470
RN  - 0 (HLA Antigens)
RN  - 0 (HLA-DQ Antigens)
RN  - 0 (Isoantibodies)
SB  - IM
MH  - Graft Rejection/prevention & control
MH  - Graft Survival
MH  - HLA Antigens
MH  - HLA-DQ Antigens
MH  - Histocompatibility Testing
MH  - Humans
MH  - Isoantibodies
MH  - *Kidney Transplantation
MH  - Tissue Donors
OTO - NOTNLM
OT  - HLA matching
OT  - HLA-DQ
OT  - antibody-mediated rejection
OT  - kidney transplantation
EDAT- 2021/07/12 06:00
MHDA- 2021/11/03 06:00
CRDT- 2021/07/11 20:33
PHST- 2021/04/30 00:00 [received]
PHST- 2021/06/01 00:00 [revised]
PHST- 2021/06/07 00:00 [accepted]
PHST- 2021/07/12 06:00 [pubmed]
PHST- 2021/11/03 06:00 [medline]
PHST- 2021/07/11 20:33 [entrez]
AID - S0085-2538(21)00657-8 [pii]
AID - 10.1016/j.kint.2021.06.026 [doi]
PST - ppublish
SO  - Kidney Int. 2021 Nov;100(5):1012-1022. doi: 10.1016/j.kint.2021.06.026. Epub 2021 
      Jul 8.