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Rethinking incompatibility in kidney transplantation
American Journal of Transplantation ( IF 8.8 ) Pub Date : 2021-08-31 , DOI: 10.1111/ajt.16826
Kyle R Jackson 1 , Dorry L Segev 1
Affiliation  

Donor/recipient incompatibility in kidney transplantation classically refers to ABO/HLA-incompatibility. Kidney paired donation (KPD) was historically established to circumvent ABO/HLA-incompatibility, with the goal of identifying ABO/HLA-compatible matches. However, there is a broad range of donor factors known to impact recipient outcomes beyond ABO/HLA-incompatibility, such as age and weight, and quantitative tools are now available to empirically compare potential living donors across many of these factors, such as the living donor kidney donor profile index (LKDPI). Moreover, the detrimental impact of mismatch at other HLA antigens (such as DQ) and epitope mismatching on posttransplant outcomes has become increasingly recognized. Thus, it is time for a new paradigm of incompatibility that considers all of these risks factors together in assessing donor/recipient compatibility and the potential utility for KPD. Under this new paradigm of incompatibility, we show how the LKDPI and other tools can be used to identify donor/recipient incompatibilities that could be improved through KPD, even for those with a traditionally "compatible" living donor.

中文翻译:

重新思考肾移植中的不相容性

肾移植中的供体/受体不相容性通常是指 ABO/HLA 不相容性。肾脏配对捐赠 (KPD) 历史上是为了规避 ABO/HLA 不相容性而建立的,目标是识别 ABO/HLA 相容性匹配。然而,除了 ABO/HLA 不相容性之外,已知影响接受者结果的捐献者因素范围很广,例如年龄和体重,现在可以使用定量工具来根据许多这些因素对潜在的活体捐献者进行经验比较,例如活体供体肾脏供体概况指数 (LKDPI)。此外,其他 HLA 抗原(如 DQ)的错配和表位错配对移植后结果的不利影响已越来越受到认可。因此,现在是时候采用一种新的不相容性范例,在评估供体/接受者相容性和 KPD 的潜在效用时将所有这些风险因素一起考虑。在这种新的不相容性范例下,我们展示了如何使用 LKDPI 和其他工具来识别可以通过 KPD 改善的供体/接受者不相容性,即使对于那些具有传统上“相容”活体供体的人也是如此。
更新日期:2021-08-31
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