HLA (emphasis on DQ) compatibility for longer allograft survival in pediatric transplantation: Modern evidence and challenges

Kidney transplantation is the treatment of choice for children with end-stage kidney failure, yet suboptimal outcomes, the need for long-term immunosuppression, and the dependency on consecutive transplants pose significant barriers to success. Providing better HLA-matched organs to pediatric patients seems to be the most logical approach to improve graft and patient outcomes and to reduce risk of anti-HLA sensitization after graft failure. We here review recent literature on HLA matching in pediatric kidney transplantation. We further review newer approaches attempting to improve matching by using molecular mismatch load analysis. Our main focus is on the role of HLA-DQ compatibility between recipient and donor. We further emphasize the need to develop creative approaches that will support HLA (and DQ) matching utilization in organ allocation schemes, at least in those geared specifically for pediatric patients.

Automated summary

Kidney transplantation is the preferred treatment for children with end-stage kidney failure, but it faces obstacles such as suboptimal outcomes and the need for long-term immunosuppression. Improving HLA matching and utilizing HLA-DQ compatibility between recipient and donor in organ allocation schemes specifically for pediatric patients can enhance graft and patient outcomes. This review discusses recent literature on HLA matching in pediatric kidney transplantation and explores new approaches utilizing molecular mismatch load analysis.