38.[20220927]Seeking Standardized Definitions for HLA-incompatible Kid…
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작성자 신호식 작성일23-02-03 13:31 조회463회 댓글0건관련링크
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Transplantation
. 2023 Jan 1;107(1):231-253. doi: 10.1097/TP.0000000000004262. Epub 2022 Aug 2.
Seeking Standardized Definitions for HLA-incompatible Kidney Transplants: A Systematic Review
Sukhdeep S Jatana 1, Hedi Zhao 1, Laurine M Bow 2, Emanuele Cozzi 3 4, Ibrahim Batal 5, Tillie Horak 6, Alexandre Amar-Zifkin 7, Carrie Schinstock 8, Medhat Askar 9 10, Darshana M Dadhania 11, Matthew Cooper 12, Maarten Naesens 13, Edward S Kraus 6, Ruth Sapir-Pichhadze 1 14; Banff Antibody-Mediated Injury Working Group
Affiliations expand
PMID: 35915547 DOI: 10.1097/TP.0000000000004262
Abstract
Background: There is no standard definition for "HLA incompatible" transplants. For the first time, we systematically assessed how HLA incompatibility was defined in contemporary peer-reviewed publications and its prognostic implication to transplant outcomes.
Methods: We combined 2 independent searches of MEDLINE, EMBASE, and the Cochrane Library from 2015 to 2019. Content-expert reviewers screened for original research on outcomes of HLA-incompatible transplants (defined as allele or molecular mismatch and solid-phase or cell-based assays). We ascertained the completeness of reporting on a predefined set of variables assessing HLA incompatibility, therapies, and outcomes. Given significant heterogeneity, we conducted narrative synthesis and assessed risk of bias in studies examining the association between death-censored graft failure and HLA incompatibility.
Results: Of 6656 screened articles, 163 evaluated transplant outcomes by HLA incompatibility. Most articles reported on cytotoxic/flow T-cell crossmatches (n = 98). Molecular genotypes were reported for selected loci at the allele-group level. Sixteen articles reported on epitope compatibility. Pretransplant donor-specific HLA antibodies were often considered (n = 143); yet there was heterogeneity in sample handling, assay procedure, and incomplete reporting on donor-specific HLA antibodies assignment. Induction (n = 129) and maintenance immunosuppression (n = 140) were frequently mentioned but less so rejection treatment (n = 72) and desensitization (n = 70). Studies assessing death-censored graft failure risk by HLA incompatibility were vulnerable to bias in the participant, predictor, and analysis domains.
Conclusions: Optimization of transplant outcomes and personalized care depends on accurate HLA compatibility assessment. Reporting on a standard set of variables will help assess generalizability of research, allow knowledge synthesis, and facilitate international collaboration in clinical trials.
Transplantation
. 2023 Jan 1;107(1):231-253. doi: 10.1097/TP.0000000000004262. Epub 2022 Aug 2.
Seeking Standardized Definitions for HLA-incompatible Kidney Transplants: A Systematic Review
Sukhdeep S Jatana 1, Hedi Zhao 1, Laurine M Bow 2, Emanuele Cozzi 3 4, Ibrahim Batal 5, Tillie Horak 6, Alexandre Amar-Zifkin 7, Carrie Schinstock 8, Medhat Askar 9 10, Darshana M Dadhania 11, Matthew Cooper 12, Maarten Naesens 13, Edward S Kraus 6, Ruth Sapir-Pichhadze 1 14; Banff Antibody-Mediated Injury Working Group
Affiliations expand
PMID: 35915547 DOI: 10.1097/TP.0000000000004262
Abstract
Background: There is no standard definition for "HLA incompatible" transplants. For the first time, we systematically assessed how HLA incompatibility was defined in contemporary peer-reviewed publications and its prognostic implication to transplant outcomes.
Methods: We combined 2 independent searches of MEDLINE, EMBASE, and the Cochrane Library from 2015 to 2019. Content-expert reviewers screened for original research on outcomes of HLA-incompatible transplants (defined as allele or molecular mismatch and solid-phase or cell-based assays). We ascertained the completeness of reporting on a predefined set of variables assessing HLA incompatibility, therapies, and outcomes. Given significant heterogeneity, we conducted narrative synthesis and assessed risk of bias in studies examining the association between death-censored graft failure and HLA incompatibility.
Results: Of 6656 screened articles, 163 evaluated transplant outcomes by HLA incompatibility. Most articles reported on cytotoxic/flow T-cell crossmatches (n = 98). Molecular genotypes were reported for selected loci at the allele-group level. Sixteen articles reported on epitope compatibility. Pretransplant donor-specific HLA antibodies were often considered (n = 143); yet there was heterogeneity in sample handling, assay procedure, and incomplete reporting on donor-specific HLA antibodies assignment. Induction (n = 129) and maintenance immunosuppression (n = 140) were frequently mentioned but less so rejection treatment (n = 72) and desensitization (n = 70). Studies assessing death-censored graft failure risk by HLA incompatibility were vulnerable to bias in the participant, predictor, and analysis domains.
Conclusions: Optimization of transplant outcomes and personalized care depends on accurate HLA compatibility assessment. Reporting on a standard set of variables will help assess generalizability of research, allow knowledge synthesis, and facilitate international collaboration in clinical trials.
