About this Research Topic
Transplantation is the treatment of choice for end-stage organ failure. However, transplant candidates who are sensitized to a wide variety of HLA antigens from prior blood transfusions, pregnancies or organ rejection have greatly reduced chances of finding a suitable donor. These patients usually have extended waiting times and succumb to the associated morbidity and mortality risks. For many highly sensitized patients, transplantation in the presence of donor-specific HLA antibodies (DSA) may be the only path forward despite the risk of antibody-mediated rejection and reduced graft survival. The current lack of diagnostics and basic understanding of HLA-specific alloimmunity limits accurate risk assessments to predict patients at greatest risk for AMR following HLA incompatible transplantation.
In the past few decades circulating HLA antibody, the final product of the humoral response became the target of desensitization. Antibody-targeting strategies such as therapeutic plasma exchange or immunoadsorption have been used in combination with intravenous immunoglobulin (IVIg) infusions and/or B cells depletion to successfully reduce circulating anti-HLA antibody (desensitized) and allow transplantation. The reduction of HLA antibodies in the recipient’s circulation prior to transplantation has been used in living donor and deceased donor organ transplantation. These conventional desensitization regimens have increased transplantation of highly sensitized patients, yet long-term outcomes remain worse than non-sensitized patient population possibly due to the inability to completely eliminate long-lived plasma cell niches as well as memory B cells. Therefore, there remains an urgent need to better understand humoral alloimmune compartments and to develop more efficacious treatment strategies to eliminate effector and memory alloimmune pathways.
In this Research Topic, we will review new and current strategies for detecting HLA sensitization and finding donors for highly sensitized patients. We will also explore new immunology research focused on measuring alloimmune compartments and emerging desensitization concepts to improve transplant outcomes. We welcome authors to submit Original Research, Review, Mini Review, Perspective, Clinical Trial, and Case Report articles focusing on, but not limited to, the following subtopics:
1. Sensitization and desensitization in various types of organ transplantation
2. New desensitization approach
3. New approaches on measuring sensitization
4. Memory B cells and plasma cells in sensitization
5. Desensitization in xenotransplantation
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.