Donor specific HLA antibody in hematopoietic stem cell transplantation: Implications for donor selection.
Donor specific HLA antibody in hematopoietic stem cell transplantation: Implications for donor selection.
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DOI：
10.3389/fimmu.2022.916200
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发表时间：
2022
影响因子：
7.3
通讯作者：
中科院分区：
文献类型：
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作者：
造血干细胞移植（HSCT）的进展导致了供体选择方法的变化。这些新方法中的许多导致更大的HLA基因座错配，无论是通过选择单倍相合的供体还是通过允许的HLA错配。虽然这些方法通过扩大可接受的供体HLA基因型的数量来增加许多患者的移植潜力，但它们增加了供体特异性HLA抗体（DSA）的潜在障碍。DSA在HSCT中提出了独特的挑战，因为它可以限制植入并导致移植失败。然而，通过脱敏治疗短暂减少HLA抗体可以限制移植失败的风险并促进植入。因此，供体选择中DSA的考虑和移植前DSA的管理在HSCT中发挥着越来越重要的作用。在这篇综述中，我们将讨论HLA抗体在HSCT中的作用，脱敏对DSA水平的影响，以及为DSA患者选择供体的意义。我们发现，有一个明确的共识，即应避免中等强度的DSA，而脱敏策略据报道，在大多数情况下，有效地减少DSA到适合的水平。关于DSA的特定特征的影响的信息有限，例如HLA基因座或总体致敏水平，这可以进一步帮助选择致敏HSCT候选人的供体。
Advances in hematopoietic stem cell transplant (HSCT) have led to changes in the approach to donor selection. Many of these new approaches result in greater HLA loci mismatching, either through the selection of haploidentical donors or permissive HLA mismatches. Although these approaches increase the potential of transplant for many patients by expanding the number of acceptable donor HLA genotypes, they add the potential barrier of donor-specific HLA antibodies (DSA). DSA presents a unique challenge in HSCT, as it can limit engraftment and lead to graft failure. However, transient reduction of HLA antibodies through desensitization treatments can limit the risk of graft failure and facilitate engraftment. Thus, the consideration of DSA in donor selection and the management of DSA prior to transplant are playing an increasingly important role in HSCT. In this review, we will discuss studies addressing the role of HLA antibodies in HSCT, the reported impact of desensitization on DSA levels, and the implications for selecting donors for patients with DSA. We found that there is a clear consensus that moderate strength DSA should be avoided, while desensitization strategies are reported to be effective in most cases at reducing DSA to amenable levels. There is limited information regarding the impact of specific characteristics of DSA, such as HLA loci or overall level of sensitization, which could further aid in donor selection for sensitized HSCT candidates.
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DOI：
10.1016/j.bbmt.2015.05.001
发表时间：
2015-08
期刊：
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
影响因子：
--
作者：
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通讯作者：
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影响因子：
7.3
作者：
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通讯作者：
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影响因子：
2.2
作者：
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通讯作者：
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DOI：
10.1038/s41573-020-00092-2
发表时间：
2021-03
期刊：
Nature reviews. Drug discovery
影响因子：
--
作者：
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通讯作者：
Gommerman JL
影响因子：
7.3
作者：
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通讯作者：
Kwon M