Application of HLA molecular level mismatching in ethnically diverse kidney transplant recipients receiving a steroid-sparing immunosuppression protocol

By: Eva Santos 1 , Katrina Spensley 2,3 , Nicola Gunby 1, Judith Worthington 4, Candice Roufosse 3,5 , Arthi Anand 1 , Michelle Willicombe 2,3,*

Published: in American Journal of Transplantation 2024

Patients: 419

Highlights:

  • Utilizing PIRCHE-II alongside HLA-Matchmaker and HLA-EMMA enhances the prediction of de novo donor-specific antibody (dnDSA) occurrence post-kidney transplant, particularly in patients managed with a steroid-sparing immunosuppression protocol.
  • Elevated PIRCHE-II molecular mismatch (MolMM) loads significantly correlate with increased risk of dnDSA development, highlighting its importance in identifying immunological risk.
  • Ethnic variations impact PIRCHE-II MolMM loads, underscoring the necessity for considering immunogenicity across diverse patient populations to better predict alloimmune responses.
  • Integration of PIRCHE-II MolMM assessment aids in pinpointing recipients at lower risk of dnDSA while undergoing minimalist immunosuppression, facilitating personalized risk stratification.
  • Immunogenic eplets identified through PIRCHE-II analysis serve as potential targets for antibody responses, emphasizing the need for further investigation into immunogenicity alongside MolMM load assessment, especially in diverse ethnic groups and under varied immunosuppression regimens.