From Humoral Theory to Performant Risk Stratification in Kidney Transplantation
The purpose of the present review is to describe how we improve the model for risk stratification of transplant outcomes in kidney transplantation by incorporating the novel insights of donor-specific anti-HLA antibody (DSA) characteristics. The detection of anti-HLA DSA is widely used for the asses...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Journal of Immunology Research |
| Online Access: | http://dx.doi.org/10.1155/2017/5201098 |
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| author | C. Lefaucheur D. Viglietti M. Mangiola A. Loupy A. Zeevi |
| author_facet | C. Lefaucheur D. Viglietti M. Mangiola A. Loupy A. Zeevi |
| author_sort | C. Lefaucheur |
| collection | DOAJ |
| description | The purpose of the present review is to describe how we improve the model for risk stratification of transplant outcomes in kidney transplantation by incorporating the novel insights of donor-specific anti-HLA antibody (DSA) characteristics. The detection of anti-HLA DSA is widely used for the assessment of pre- and posttransplant risks of rejection and allograft loss; however, not all anti-HLA DSA carry the same risk for transplant outcomes. These antibodies have been shown to cause a wide spectrum of effects on allografts, ranging from the absence of injury to indolent or full-blown acute antibody-mediated rejection. Consequently, the presence of circulating anti-HLA DSA does not provide a sufficient level of accuracy for the risk stratification of allograft outcomes. Enhancing the predictive performance of anti-HLA DSA is currently one of the most pressing unmet needs for facilitating individualized treatment choices that may improve outcomes. Recent advancements in the assessment of anti-HLA DSA properties, including their strength, complement-binding capacity, and IgG subclass composition, significantly improved the risk stratification model to predict allograft injury and failure. Although risk stratification based on anti-HLA DSA properties appears promising, further specific studies that address immunological risk stratification in large and unselected populations are required to define the benefits and cost-effectiveness of such comprehensive assessment prior to clinical implementation. |
| format | Article |
| id | doaj-art-8f85b04d8f7e40d59b1125853a93d784 |
| institution | OA Journals |
| issn | 2314-8861 2314-7156 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Immunology Research |
| spelling | doaj-art-8f85b04d8f7e40d59b1125853a93d7842025-08-20T02:09:28ZengWileyJournal of Immunology Research2314-88612314-71562017-01-01201710.1155/2017/52010985201098From Humoral Theory to Performant Risk Stratification in Kidney TransplantationC. Lefaucheur0D. Viglietti1M. Mangiola2A. Loupy3A. Zeevi4Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, FranceParis Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, FranceDepartment of Transplant Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USAParis Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, FranceDepartment of Transplant Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USAThe purpose of the present review is to describe how we improve the model for risk stratification of transplant outcomes in kidney transplantation by incorporating the novel insights of donor-specific anti-HLA antibody (DSA) characteristics. The detection of anti-HLA DSA is widely used for the assessment of pre- and posttransplant risks of rejection and allograft loss; however, not all anti-HLA DSA carry the same risk for transplant outcomes. These antibodies have been shown to cause a wide spectrum of effects on allografts, ranging from the absence of injury to indolent or full-blown acute antibody-mediated rejection. Consequently, the presence of circulating anti-HLA DSA does not provide a sufficient level of accuracy for the risk stratification of allograft outcomes. Enhancing the predictive performance of anti-HLA DSA is currently one of the most pressing unmet needs for facilitating individualized treatment choices that may improve outcomes. Recent advancements in the assessment of anti-HLA DSA properties, including their strength, complement-binding capacity, and IgG subclass composition, significantly improved the risk stratification model to predict allograft injury and failure. Although risk stratification based on anti-HLA DSA properties appears promising, further specific studies that address immunological risk stratification in large and unselected populations are required to define the benefits and cost-effectiveness of such comprehensive assessment prior to clinical implementation.http://dx.doi.org/10.1155/2017/5201098 |
| spellingShingle | C. Lefaucheur D. Viglietti M. Mangiola A. Loupy A. Zeevi From Humoral Theory to Performant Risk Stratification in Kidney Transplantation Journal of Immunology Research |
| title | From Humoral Theory to Performant Risk Stratification in Kidney Transplantation |
| title_full | From Humoral Theory to Performant Risk Stratification in Kidney Transplantation |
| title_fullStr | From Humoral Theory to Performant Risk Stratification in Kidney Transplantation |
| title_full_unstemmed | From Humoral Theory to Performant Risk Stratification in Kidney Transplantation |
| title_short | From Humoral Theory to Performant Risk Stratification in Kidney Transplantation |
| title_sort | from humoral theory to performant risk stratification in kidney transplantation |
| url | http://dx.doi.org/10.1155/2017/5201098 |
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