Transplantation Genetics: The Importance of non-HLA Antibodies, Genetic Insights and Future Perspectives

Solid organ transplantation is an effective and life-saving treatment method for patients with end-stage organ failure. Immunological evaluation is of great importance in the achievement of transplantation, and the determination of HLA incompatibility forms the basis of immunological transplantation success. The presence of donor HLA-related antibodies is known to be asssociated with graft loss and decreased survival rates. However, recent studies have shown clinical and experimental findings related to the important role of non-HLA antibodies in the antibody-mediated rejection and chronic rejection process. The mechanisms triggering auto-antibody production in organ transplantation are an important area of research. These mechanisms stimulate auto-antibody production in the patient causing the expression of organ-origin autoantigens such as ischaemia-reperfusion damage, surgical trauma, alloimmune responses, soluble antigens, extracellular vesicles and apoptotic bodies. In patients with a risk of non-HLA antibody-mediated rejection, there is an urgent need to determine the recipient immunological phenotypes, both for the development of targetted treatments and to increase both graft and patient survival. The aim of this review was to evaluate non-HLA antibody types and their effects on transplantation.