Immunocompatibility in transplantation: adapting to a changing therapeutic landscape

Abstract

Compatibilitat HLA; Teràpies emergents; Immunosupressió

HLA match; Emerging therapies; Immunosupression

Compatibilidad HLA; Terapias emergentes; Inmunosupresión

The ongoing shortage of cell, tissue, and organ donors has led to prioritizing clinical urgency over optimal immune matching in transplantation, often at the cost of increased reliance on immunosuppressive regimens and their associated adverse effects. Recent advances in the use of Substances of Human Origin (SoHOs), xenotransplantation and emerging cell-, gene-, and tissue-based therapies have enabled the development of tailored cellular therapeutics to enhance engraftment, long-term function, and immunological compatibility. Within this evolving context, artificial intelligence is also increasingly contributing to improve donor–recipient matching through predictive analytics and integrative data modeling, assisting on immune tolerance and the durable integration of transplanted cells into host tissues. In this review, we revisit foundational concepts of immunocompatibility, examine current clinical criteria in organ transplantation, and critically explore the shifting paradigms of donor–recipient matching in the era of personalized medicine. These advances have the potential to redefine clinical strategies in transplantation and regenerative care while ensuring patient access and sustainability.

The author(s) declare financial support was received for the research and/or publication of this article. JV’s laboratory is a member of the Red Española de Terapias Avanzadas (RICORS-TERAV/TERAV+, file nos. RD21/0017/0022 and RD24/0014/0037, PI: JV), funded by the Instituto de Salud Carlos III (ISCiii) in the context of NextGenerationEU Recovery, Transformation and Resilience Plan. The joint BST-VHIR Musculoskeletal Tissue Engineering Group is a Consolidated Research Group accredited by the Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR) of the Generalitat de Catalunya (file no. 2021-SGR-00877). RG-A is recipient of a PhD fellowship from the VHIR PhD call funded by Vall Hebron Research Institute (VHIR) - Amics del VHIR.