Abstract
In previous statistical analyses we have demonstrated the importance of the dualistic effect of HLA on liver transplant survival: HLA compatibility decreases cellular rejection but also increases other immunologically mediated, HLA-restricted mechanisms of allograft injury. More recently these results have been confirmed by other researchers, and several studies have shown higher recurrence rates of infectious diseases such as hepatitis B and C and CMV hepatitis for HLA-compatible liver transplants. Although current practice does not consider HLA in liver transplantation, cellular in vitro studies show a significant role of HLA antigens in clinically relevant phenomena. While increasing the amount of infection-related immune damage, HLA compatibility also decreases the alloproliferative response of the recipient to the donor tissue. Further studies must examine whether non-HLA antigens such as tissue-specific antigens and heat-shock-proteins participate in this process, and how target cells can present different peptides such as soluble HLA antigens or viral proteins to the recipient.
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