Choosing the Right Patient for Lung Transplantation: Assessment of Histocompatibility and Sensitization Status

A comprehensive assessment of human leukocyte antigen (HLA) compatibility is crucial for successful lung transplantation and long-term survival of allografts. In this review, the authors summarize commonly used clinical tests in histocompatibility laboratories, such as HLA typing, crossmatch using conventional complement-dependent cytotoxic (CDC) assay or flow cytometry, and recently emerged solid-phase assays using multiple or single antigen beads on the Luminex platform. Challenges for solid-phase assays and modified versions to detect complement-fixing antibodies, such as C1q or C3d assays, are also reviewed. The strengths and weaknesses of each assay are compared and contrasted. Clinical cases are used to explain the best practice of stratifying immunological risk for lung transplant candidates and guiding the treatment of antibody-mediated rejection posttransplantation. Specifically, the authors highlight the importance of using serum titration to thoroughly evaluate the real strength of anti-HLA antibodies and using the C1q assay to detect clinically relevant antibodies that are responsive to treatment. It is necessary to use multiple tests to assess histocompatibility and sensitization status. It takes a team – transplant physicians, surgeons, pharmacists, and histocompatibility specialists – working together to provide personalized care for lung transplant patients.