Despite its recent decline in volumes, intestinal transplantation remains an important option for patients with irreversible intestinal failures. The long-term outcome of an intestinal transplant has stagnated. The major cause of graft loss is rejection, resulting from mismatches in human leukocyte antigens (HLA) and the presence of antibodies to mismatched donor-specific HLA antigens (DSA). Literature has reported that DSAs, either preformed before transplantation or developed de novo after transplantation, are harmful to intestinal grafts, especially for those without combined liver grafts. A comprehensive assessment of DSA by the histocompatibility laboratory is critical for successful intestinal transplantation and its long-term survival. This paper briefly reviews the history and current status of different methods for detecting DSA and their clinical applications in intestinal transplantation. The focus is on applying different antibody assays to manage immunologically challenging intestinal transplant patients before and after transplantation. A clinical case is presented to illustrate the complexity of HLA tests and the necessity of multiple assays. The review of risk assessment by the histocompatibility laboratory also highlights the need for close interaction between the laboratory and the intestinal transplant program.

中文翻译：

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目前肠道移植患者风险评估的方法：来自组织相容性实验室的观点

尽管最近肠道移植量有所下降，但对于不可逆性肠道衰竭患者来说，肠道移植仍然是一个重要的选择。肠道移植的长期结果已经停滞不前。移植物丢失的主要原因是排斥反应，这是由于人类白细胞抗原 (HLA) 不匹配以及针对不匹配的供体特异性 HLA 抗原 (DSA) 的抗体的存在造成的。文献报道，无论是移植前进行的DSA还是移植后重新开发的DSA，都对肠移植物有害，特别是对于那些没有联合肝移植的患者。组织相容性实验室对 DSA 的全面评估对于肠移植的成功及其长期生存至关重要。本文简要回顾了不同DSA检测方法的历史和现状及其在肠移植中的临床应用。重点是应用不同的抗体检测来管理移植前后免疫挑战性的肠道移植患者。通过一个临床案例来说明 HLA 检测的复杂性和多种检测的必要性。组织相容性实验室对风险评估的审查也强调了实验室与肠道移植项目之间密切互动的必要性。