Stratifying the humoral risk of candidates to a solid organ transplantation: a proposal of the ENGAGE working group
Stratifying the humoral risk of candidates to a solid organ transplantation: a proposal of the ENGAGE working group
复制标题
DOI：
10.1111/tri.13874
复制
发表时间：
2021-04-22
影响因子：
3.1
通讯作者：
Thaunat, Olivier
中科院分区：
文献类型：
--
作者：
Bestard, Oriol;Couzi, Lionel;Thaunat, Olivier
针对人类白细胞抗原 (HLA) 分子的循环抗体的检测（对应于“致敏患者”的当前定义）已被证明对移植的机会以及移植物的存活（如果抗 HLA 抗体对所选供体具有特异性）产生严重影响。然而，并非所有的供体特异性抗体 (DSA) 对移植物都同样有害，并且对体液记忆理解的进展得出这样的结论：移植时缺乏 DSA 并不排除患者对移植物具有预先形成的细胞体液记忆的可能性（从而定义了一类 DSA 阴性致敏受体）。技术进步催生了新的检测方法，这些检测方法在探索同种免疫体液记忆的不同层（血清学和细胞学）方面提供了前所未有的精度。根据这一最新知识，欧洲移植受者管理指南 (ENGAGE) 工作组提出了实体器官移植候选者致敏的更新定义，该定义从当前的二元划分转向基于具有相似体液风险的同质层的定义。
Detection of circulating antibodies directed against human leukocyte antigen (HLA) molecules, which corresponds to the current definition of 'sensitized patient', has been shown to have a severe impact on both access to transplantation and, if the anti-HLA antibodies are specific to the selected donor, survival of the graft. However, not all donor-specific antibodies (DSA) are equally harmful to the graft and progress in the understanding of humoral memory has led to the conclusion that absence of DSA at transplantation does not rule out the possibility that the patient has a preformed cellular humoral memory against the graft (thereby defining a category of DSA-negative sensitized recipients). Technological progress has led to the generation of new assays that offer unprecedented precision in exploring the different layers (serological and cellular) of alloimmune humoral memory. Based on this recent knowledge, the EuropeaN Guidelines for the mAnagement of Graft rEcipients (ENGAGE) working group to propose an updated definition of sensitization in candidates for solid organ transplantation - one that moves away from the current binary division towards a definition based on homogenous strata with similar humoral risk.