Non-HLA Antibodies in Clinical Transplantation.

Organ transplantation overcomes conservative therapy to improve patient longevity. Despite the improvement of donor-recipient compatibility tests and intensified immunosuppressive agents, long-term graft survival remains poor because of acute and chronic injury driven by immunologic and non-immunologic factors. The significant immunological barrier for graft longevity is antibody-mediated rejection. Antibodies reactive to donor-specific human leukocyte antigens (HLA) have been shown to have adverse effects on the transplanted organ. However, there is minimal or controversial data supporting a pathogenic effect of antibodies against non-HLAs. This review discusses non-HLA antibodies and relevant antigen targets that have been uncovered by molecular medicine and correspond with acute rejection and chronic allograft injury. Updated proteomic evaluation may improve our knowledge of the immune response by enhancing immunologic epitope determination outside the scope of HLA.