Should We Revisit HLA Matching to Improve Long-Term Graft Outcomes?

Purpose of Review: We present here an overview of the needs and requirements for human leukocyte antigen (HLA) matching, explain and explore the potential benefits of epitope matching, and discuss the benefits of allele-level high-resolution matching at all HLA loci, i.e. HLA-A, -B, -DR, -DQ and -DP, for donor selection needs during renal transplantation. Recent Findings: Donor recipient HLA matching has a substantial impact on organ transplantation by prolonging graft survival, minimizing rejection episodes, preventing sensitization, providing a better chance for retransplantation and reducing the percentage of deaths due to graft dysfunction. Despite these advantages, the utility of HLA matching has been challenged, mainly because of the availability of highly effective immunosuppressive agents clubbed with steady improvements in short-term graft survival. Moreover, the risk associated with prolonged periods on dialysis while waiting for an optimally matched donor is minimized. Summary: There is a need to strike a balance between the benefits of HLA matching and problems associated with finding such a donor. A more viable alternative would be to find a donor with mismatches having a low probability of inducing humoral responses. © 2018, Springer International Publishing AG, part of Springer Nature.