ABSTRACT
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The importance of detecting antibody to human leukocyte antigens (HLA) has been known since the early years of clinical organ transplantation. The association of hyperacute rejection of kidney grafts with preexisting humoral antibody to donor cells represented a seminal fi nding in organ transplantation [1-4]. Since then, screening for donor-specifi c antibody (DSA) present in transplant patients has become one of the most important tests performed in the HLA laboratory. The total accumulation of data available today supports the utility of this practice and provides insight into the relevance of HLA antibody and the utility of multiple assays for both solid organ and stem cell transplantation. Most importantly, recent advances in antibody testing techniques have made antibody detection and identifi cation easier for the transplant community. With the current techniques available for testing, detailed antibody studies for individual patients can be performed. Thus, a better understanding of patient antibody profi les can provide a better assessment of potential immunologic risk. Advances in immunosuppression and therapies for treating antibody-mediated rejection have shown that the presence of DSA is no longer an obligatory contraindication to transplantation but represents a “risk factor” that is taken into consideration when determining the appropriateness of transplantation. This chapter describes data on HLA antibody detection and its association with graft outcome. Additionally, we provide brief discussions on the methods used for HLA antibody detection and characterization.
