Journal d'immunologie clinique et cellulaire
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Diagnostic Challenges and Immunological Barriers in Kidney Transplantation

Rayan Bawayan*, Khalid Elhassan, Ashraf Dada

The presence of donor specific antibodies and HLA-incompatibility between waiting list patients and potential donors make transplantation programs worldwide complicated and stand as a major barrier for a quick access for organ transplantation. Especially in kidney transplantation, the effector HLA antibodies are the most important reason for graft failures and antibody mediated rejection. At the same time, the demand for kidney transplantation is increasing remarkably worldwide, due to the continuously Raising number of patients with end stage renal disease. For these patients, hemodialysis was regularly considered as an intermediate step only and the ideal goal is to find a suitable kidney as early as possible. However, in case of HLA-incompatibility, the waiting time for an organ is too long and often accompanied with dialysis associated multiple diseases, including physical, social and psychological complications, especially in patients with additional limiting factors, like ABO incompatibility or multi-morbidity. This article provides an overview of the current diagnostic tools for an accurate testing, identification and analysis of HLA-antibodies and addresses the remaining concerns related to their clinical and immunological relevance. It reviews the increasing role of different technologies and approaches to overcome the immunological barriers in kidney transplantation, including the extracorporeal removal of clinically relevant antibodies. In addition, the review suggests avenues for future research on overcoming immunological challenges and inducing immune tolerance in kidney transplantation.