My approach to the immunogenetics of haematopoietic stem cell transplant matching: Figure 1

Abstract

Haematopoietic stem cell transplantation (HSCT) is now viewed as an effective treatment modality for a wide and varied number of diseases including both malignant and non-malignant haematological diseases, bone marrow failures, inherited immunodeficiencies and congenital metabolic disorders. This review will discuss the immunogenetic factors that play an influential role in the successful outcome of HSCT, most importantly the human leucocyte antigens (HLAs). Advances in HLA typing techniques enabling the definition of HLA types at the allele level have made it possible to investigate the impact of mismatching at individual HLA loci on HSCT outcome. Such studies have informed the strategy used for selection of both related and unrelated donors. This strategy, including the histocompatibility and immunogenetics laboratory testing required, is discussed in the context of published data, guidelines and recommendations. THE HLA SYSTEMThe HLA system has long been implicated as central to the successful outcome of haematopoietic stem cell transplantation (HSCT). The importance of matching patient and donor for HLA class I (A and B) and class II (DR) has long been established. 1e4 The advent of the molecular era has allowed H&I scientists to further elucidate and reveal the complexity and extent of the polymorphism found in HLA genes. These advances have posed an ever increasing challenge to the histocompatibility and immunogenetics (H&I) laboratory to find the optimal donor for a patient requiring HSCT.

Current Concepts in Histocompatibility During Heart Transplant

“…14,15 controversial issues in human leukocyte antigen matching in a heart transplant The importance of HLA matching to improve outcome in kidney and bone marrow transplant has been widely accepted, whereas it is still debated in heart transplants. [16][17][18] There is a paucity of research on the clinical relevance of HLA matching in heart transplanting, because the HLA is not a selection criterion of the recipient's choice. Furthermore, heart disease patients have a severe short-term prognosis, and they cannot wait for a heart transplant with a high degree of HLA histocompatibility.…”