The clinical significance of epitope mismatch load in kidney transplantation: A multicentre study

Since the advent of kidney transplantation a key strategy for maximising graft survival by avoiding allorecognition has been to minimise HLA mismatching between donor and recipient. As HLA antibodies are now recognised as being specific for epitopes and donor-recipient HLA mismatch at the amino acid level can now be determined, HLA epitope mismatch load could be a better predictor for dnDSA development than classical HLA antigen mismatch calculation. This hypothesis has been investigated by other studies and the aim of our multicentre study was to confirm this observation in our population. Two algorithms, HLAMatchmaker and PIRCHE-II, were used to determine the HLA epitope mismatch load between donor and recipient. We have shown a significant association between the number of HLA epitope mismatches and the development of dnDSA and we have confirmed the earlier observations.