Departments > Clinical Transplantation

The extreme polymorphism of HLA has been driven by selection for pathogen resistance. The human leukocyte antigen (HLA) system forms the basis for self and allows the adaptive immune system to recognise these pathogens. The HLA system forms the basis for T cell receptor recognition, acts as a ligand for the KIR natural killer receptor and antibodies to HLA are a major contra-indication to solid organ transplantation.

HLA has been the focus of my scientific interest throughout my working life. Arriving at Guy’s Hospital fresh from University I entered the Tissue Typing laboratory in 1972. Since then I have seen the profession grow, all HLA definition is now based on genes rather than the expressed glycol-proteins, antibody definition is through flow cytometry. As HLA is pivotal to the immune response many diseases and adverse drug reactions have been shown to have an HLA association. Two of these have been discovered in the laboratory, the association of narcolepsy with DR15 DQB1*0602 and actinic prurigo with DRB1*0407. Both of these associations have been shown to be diagnostically useful.

Research within the laboratory is now centred on antibody removal to facilitate renal transplantation and an attempt to translate the enormous diversity of HLA alleles into something a little more practical. Most users do not want to know the complete HLA type just the presence or absence of the functionally relevant motifs.