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Donor specific HLA antibody in hematopoietic stem cell transplantation: Implications for donor selection
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 th...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390945/ https://www.ncbi.nlm.nih.gov/pubmed/35990679 http://dx.doi.org/10.3389/fimmu.2022.916200 |
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author | Krummey, Scott M. Gareau, Alison J. |
author_facet | Krummey, Scott M. Gareau, Alison J. |
author_sort | Krummey, Scott M. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9390945 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-93909452022-08-20 Donor specific HLA antibody in hematopoietic stem cell transplantation: Implications for donor selection Krummey, Scott M. Gareau, Alison J. Front Immunol Immunology 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. Frontiers Media S.A. 2022-08-05 /pmc/articles/PMC9390945/ /pubmed/35990679 http://dx.doi.org/10.3389/fimmu.2022.916200 Text en Copyright © 2022 Krummey and Gareau https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Immunology Krummey, Scott M. Gareau, Alison J. Donor specific HLA antibody in hematopoietic stem cell transplantation: Implications for donor selection |
title | Donor specific HLA antibody in hematopoietic stem cell transplantation: Implications for donor selection |
title_full | Donor specific HLA antibody in hematopoietic stem cell transplantation: Implications for donor selection |
title_fullStr | Donor specific HLA antibody in hematopoietic stem cell transplantation: Implications for donor selection |
title_full_unstemmed | Donor specific HLA antibody in hematopoietic stem cell transplantation: Implications for donor selection |
title_short | Donor specific HLA antibody in hematopoietic stem cell transplantation: Implications for donor selection |
title_sort | donor specific hla antibody in hematopoietic stem cell transplantation: implications for donor selection |
topic | Immunology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390945/ https://www.ncbi.nlm.nih.gov/pubmed/35990679 http://dx.doi.org/10.3389/fimmu.2022.916200 |
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