HLA Epitope Mismatch Load (epMM) Allows Classification of Immunological Risk and Correlates with Patient Survival Following Lung Transplantation (LTx)

Hiho, Steven; Paraskeva, Miranda; Walton, D.C.; Diviney, Mary; Levvey, B.; Snell, G.I.; Sullivan, Lucy C.; Westall, Glen P.

doi:10.1016/j.healun.2020.01.795

Cited by 2 publications

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“…The immunologic LTx focus for the last decade has been avoid matching a recipient to a specific donor where significant DSAs to that donor's HLA are already present. A pre‐LTx virtual cross match has proved robust at alerting clinicians to particularly adverse combinations 81,82 . Where there is uncertainty a solid‐phase Hallifaster crossmatch assessment can add further prognostic information 80 .…”

Section: Lung Donor and Recipient Matching And Compatibilitymentioning

confidence: 99%

Advances in lung transplantation: 60 years on

Paraskeva,

Snell

2024

Respirology

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Lung transplantation is a well‐established treatment for advanced lung disease, improving survival and quality of life. Over the last 60 years all aspects of lung transplantation have evolved significantly and exponential growth in transplant volume. This has been particularly evident over the last decade with a substantial increase in lung transplant numbers as a result of innovations in donor utilization procurement, including the use donation after circulatory death and ex‐vivo lung perfusion organs. Donor lungs have proved to be surprisingly robust, and therefore the donor pool is actually larger than previously thought. Parallel to this, lung transplant outcomes have continued to improve with improved acute management as well as microbiological and immunological insights and innovations. The management of lung transplant recipients continues to be complex and heavily dependent on a tertiary care multidisciplinary paradigm. Whilst long term outcomes continue to be limited by chronic lung allograft dysfunction improvements in diagnostics, mechanistic understanding and evolutions in treatment paradigms have all contributed to a median survival that in some centres approaches 10 years. As ongoing studies build on developing novel approaches to diagnosis and treatment of transplant complications and improvements in donor utilization more individuals will have the opportunity to benefit from lung transplantation. As has always been the case, early referral for transplant consideration is important to achieve best results.

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Section: Lung Donor and Recipient Matching And Compatibilitymentioning

confidence: 99%

Advances in lung transplantation: 60 years on

Paraskeva,

Snell

2024

Respirology

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“…An important determinant of a long-term beneficial posttransplant outcome is undoubtably the degree of HLA mismatch with an increased number of human leucocyte antigen (HLA) mismatches leading to higher risk of graft failure. Reducing the level of HLA mismatching, in either T-cell or B-cell epitopes, electrostatic differences or amino acid was shown to improve outcomes following LTx as HLA-DRB1345 matching was associated with freedom from RAS and HLA-DQ matching was associated with reduced donor-specific antibody (DSA) development and therefore indirectly also reduced CLAD development [25]. This was specifically confirmed for high-risk epitope mismatch found in DQA1Ã05 þ DQB1Ã02/DQB1Ã03 : 01, which was associated with DSA and CLAD development [26].…”

Section: Clinical Risk Factorsmentioning

confidence: 99%

The diagnosis and management of chronic lung allograft dysfunction

Verleden,

Hendriks,

Verleden

2024

Current Opinion in Pulmonary Medicine

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Purpose of review Chronic lung allograft dysfunction (CLAD) remains a life-threatening complication following lung transplantation. Different CLAD phenotypes have recently been defined, based on the combination of pulmonary function testing and chest computed tomography (CT) scanning and spurred renewed interests in differential diagnosis, risk factors and management of CLAD. Recent findings Given their crucial importance in the differential diagnosis, we will discuss the latest development in assessing the pulmonary function and chest CT scan, but also their limitations in proper CLAD phenotyping, especially with regards to patients with baseline allograft dysfunction. Since no definitive treatment exists, it remains important to timely identify clinical risk factors, but also to assess the presence of specific patterns or biomarkers in tissue or in broncho alveolar lavage in relation to CLAD (phenotypes). We will provide a comprehensive overview of the latest advances in risk factors and biomarker research in CLAD. Lastly, we will also review novel preventive and curative treatment strategies for CLAD. Summary Although this knowledge has significantly advanced the field of lung transplantation, more research is warranted because CLAD remains a life-threatening complication for all lung transplant recipients.

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HLA Epitope Mismatch Load (epMM) Allows Classification of Immunological Risk and Correlates with Patient Survival Following Lung Transplantation (LTx)

Cited by 2 publications

References 0 publications

Advances in lung transplantation: 60 years on

Advances in lung transplantation: 60 years on

The diagnosis and management of chronic lung allograft dysfunction

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