High-resolution human leukocyte antigen typing and early post-transplant outcomes: more than meets the eye

Human leukocyte antigen (HLA) compatibility guides organ distribution across different solid organ transplants. However, for lung transplantation (LTx), this proves unmanageable due to the scarcity of available lung allografts and the limited graft ischemic time. This shortcoming has several consequences; studies have shown that HLA antigen mismatches increase the risk of de novo donor-specific antibody (DSA) development which leads to an increased risk of chronic lung allograft dysfunction (CLAD) and subsequent mortality after LTx (1-4). Even though complete HLA compatibility for lung transplant recipients is unattainable, avoidance of certain HLA is necessary in specific patient populations (i.e., patients on the lung transplant waiting list who already show pre-transplant anti- HLA antibodies).