Histocompatibility and Immunogenetics

Organs transplanted between genetically different individuals are recognised as foreign by the host immune system, and in the absence of immunosuppressive therapy, are rapidly rejected. The main target for rejection is mismatched donor HLA and strategies to match donor and recipient HLA types are effective to reduce the incidence of rejection and the requirement for immunosuppressive drugs. Many patients awaiting kidney and pancreas transplantation have had previous exposure to foreign HLA and are immunologically primed to mismatched donor HLA, identified by the presence of HLA-specific antibodies in patient serum, which can cause irreversible humoral rejection. It is therefore important to identify and avoid certain HLA-specific antibody-incompatible donor-recipient combinations. This chapter describes the laboratory techniques used for HLA typing and the detection of HLA-specific antibody, and their clinical application to guide immunological risk assessment in the selection of suitable donor and recipient pairs for kidney and pancreas transplantation. © 2012 John Wiley & Sons, Ltd.