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Should HLA Mismatch Acceptability for Sensitized Transplant Candidates Be Determined at the High-Resolution Rather Than the Antigen Level?

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Defining HLA mismatch acceptability of organ transplant donors for sensitized recipients has traditionally been based on serologically defined HLA antigens. Now, however, it is well accepted that HLA antibodies specifically recognize a wide range of epitopes present on HLA antigens and that molecularly defined high resolution alleles corresponding to the same low resolution antigen can possess different epitope repertoires. Hence, determination of HLA compatibility at the allele level represents a more accurate approach to identify suitable donors for sensitized patients. This approach would offer opportunities for increased transplant rates and improved long term graft survivals.

Alloantibody
immunogenetics
major histocompatibility complex (MHC)
panel reactive antibody (PRA)
sensitization

Abbreviations

cPRA
calculated panel reactive antibody
NMDP
National Marrow Donor Program
SAB
single allele bead
UNOS
United Network for Organ Sharing

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