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. 2023 Jan 1;107(1):231-253.
doi: 10.1097/TP.0000000000004262. Epub 2022 Aug 2.

Seeking Standardized Definitions for HLA-incompatible Kidney Transplants: A Systematic Review

Sukhdeep S Jatana  1 , Hedi Zhao  1 , Laurine M Bow  2 , Emanuele Cozzi  3   4 , Ibrahim Batal  5 , Tillie Horak  6 , Alexandre Amar-Zifkin  7 , Carrie Schinstock  8 , Medhat Askar  9   10 , Darshana M Dadhania  11 , Matthew Cooper  12 , Maarten Naesens  13 , Edward S Kraus  6 , Ruth Sapir-Pichhadze  1   14 ; Banff Antibody-Mediated Injury Working Group
Affiliations

Seeking Standardized Definitions for HLA-incompatible Kidney Transplants: A Systematic Review

Sukhdeep S Jatana et al. Transplantation. .

Abstract

Background: There is no standard definition for "HLA incompatible" transplants. For the first time, we systematically assessed how HLA incompatibility was defined in contemporary peer-reviewed publications and its prognostic implication to transplant outcomes.

Methods: We combined 2 independent searches of MEDLINE, EMBASE, and the Cochrane Library from 2015 to 2019. Content-expert reviewers screened for original research on outcomes of HLA-incompatible transplants (defined as allele or molecular mismatch and solid-phase or cell-based assays). We ascertained the completeness of reporting on a predefined set of variables assessing HLA incompatibility, therapies, and outcomes. Given significant heterogeneity, we conducted narrative synthesis and assessed risk of bias in studies examining the association between death-censored graft failure and HLA incompatibility.

Results: Of 6656 screened articles, 163 evaluated transplant outcomes by HLA incompatibility. Most articles reported on cytotoxic/flow T-cell crossmatches (n = 98). Molecular genotypes were reported for selected loci at the allele-group level. Sixteen articles reported on epitope compatibility. Pretransplant donor-specific HLA antibodies were often considered (n = 143); yet there was heterogeneity in sample handling, assay procedure, and incomplete reporting on donor-specific HLA antibodies assignment. Induction (n = 129) and maintenance immunosuppression (n = 140) were frequently mentioned but less so rejection treatment (n = 72) and desensitization (n = 70). Studies assessing death-censored graft failure risk by HLA incompatibility were vulnerable to bias in the participant, predictor, and analysis domains.

Conclusions: Optimization of transplant outcomes and personalized care depends on accurate HLA compatibility assessment. Reporting on a standard set of variables will help assess generalizability of research, allow knowledge synthesis, and facilitate international collaboration in clinical trials.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Warren DS, Zachary AA, Sonnenday CJ, et al. Successful renal transplantation across simultaneous ABO incompatible and positive crossmatch barriers. Am J Transplant. 2004;4:561–568.
    1. Sharif A, Kraus ES, Zachary AA, et al. Histologic phenotype on 1-year posttransplantation biopsy and allograft survival in HLA-incompatible kidney transplants. Transplantation. 2014;97:541–547.
    1. Orandi BJ, Luo X, Massie AB, et al. Survival benefit with kidney transplants from HLA-incompatible live donors. N Engl J Med. 2016;374:940–950.
    1. Orandi BJ, Garonzik-Wang JM, Massie AB, et al. Quantifying the risk of incompatible kidney transplantation: a multicenter study. Am J Transplant. 2014;14:1573–1580.
    1. Montgomery RA, Zachary AA, Ratner LE, et al. Clinical results from transplanting incompatible live kidney donor/recipient pairs using kidney paired donation. JAMA. 2005;294:1655–1663.

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