Current methodologies for detecting sensitization to HLA antigens.

PURPOSE OF REVIEW: Advances in solid-phase tests for antibodies directed against HLA antigens have opened new areas of sophistication in detecting and characterizing the antibodies and have improved access to transplantation for sensitized candidates. In considering desensitization as an option for sensitized patients, determining specificities and strengths of antibodies and the risk they pose before and after therapeutic interventions are critical. This review focuses on the tests that are used today to detect sensitization and their relevance to assessing risk for transplant candidates and recipients. RECENT FINDINGS: There are conflicting reports of the clinical relevance of antibodies that are detected in solid-phase assays, which provide exquisite levels of precision and sensitivity for antibody detection. There is growing evidence that low levels of donor-reactive antibody need not be always considered a contraindication to transplant. New tools for determining isotype and complement fixation in solid-phase tests may also resolve some disparities. SUMMARY: Solid-phase tests for HLA antibodies now play a key role in transplantation laboratories and are widely utilized by transplant programs around the world. Although there are not rigid standards for their use and interpretation, transplant patients are benefiting from the use of these tests.