Can We Use Eplets (or Molecular) Mismatch Load Analysis to Improve Organ Allocation? The Hope and the Hype.

Content Provider	Europe PMC
Author	Tambur, Anat R. Das, Rajdeep
Copyright Year	2022
Abstract	In recent years, there have been calls for implementation of “epitope matching” in deceased-donor organ allocation policies (later changed to “eplet matching”). Emerging data indeed support the use of molecular mismatch load analysis in specific patient groups, with the objective of posttransplant stratification into different treatment arms. For this purpose, the expectation is to statistically categorize patients as low- or high-immune-risk. Importantly, these patients will continue to be monitored‚ and their risk category, as well as their management, can be adjusted according to on-going findings. However, when discussing deceased donor organ allocation and matching algorithms, where the decision is not modifiable and has lasting impact on outcomes, the situation is fundamentally different. The goal of changing allocation schemes is to achieve the best possible HLA compatibility between donor and recipient. Immunologically speaking, this is a very different objective. For this purpose, the specific interplay of immunogenicity between the donor and any potential recipient must be understood. In seeking compatibility, the aim is not to redefine matching but to identify those mismatches that are “permissible” or‚ in other words, less immunogenic. In our eagerness to improve transplant outcome, unfortunately, we have conflated the hype with the hope. Terminology is used improperly, and new terms are created in the process with no sufficient support. Here, we call for a cautious evaluation of baseline assumptions and a critical review of the evidence to minimize unintended consequences.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC9944744&blobtype=pdf
ISSN	00411337
Journal	Transplantation
Volume Number	107
PubMed Central reference number	PMC9944744
Issue Number	3
PubMed reference number	36163639
e-ISSN	15346080
DOI	10.1097/tp.0000000000004307
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2022-09-27
Publisher Place	Hagerstown, MD
Access Restriction	Open
Rights License	This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
Content Type	Text
Resource Type	Article
Subject	Transplantation