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Personalized Peptide Arrays for Detection of HLA Alloantibodies in Organ Transplantation
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Molecular diagnostics in HLA-incompatible kidney transplantation.

Miray Guney1, Petra Hruba2, Ondrej Viklicky3

  • 1Transplant Laboratory, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; First Faculty of Medicine, Charles University, Prague, Czech Republic.

Transplantation Reviews (Orlando, Fla.)
|February 25, 2026
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Summary
This summary is machine-generated.

Human leukocyte antigen-incompatible kidney transplants face antibody-mediated rejection. Advanced diagnostics like transcriptomics and cell-free DNA show promise in early detection and management of rejection in these high-risk patients.

Keywords:
Antibody-mediated, rejectionHLA-incompatible kidney transplantationHighly sensitized patientsImlifidaseMolecular diagnosticsNon-invasive, biomarkersTissue-based transcriptomics

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Area of Science:

  • Nephrology
  • Immunology
  • Transplant Science

Background:

  • Human leukocyte antigen-incompatible (HLA-i) kidney transplantation is crucial for highly sensitized patients but has high rates of antibody-mediated rejection (AMR) due to early donor-specific antibody (DSA) rebound and alloimmune injury.
  • Conventional kidney allograft biopsy and histology may not detect early or subclinical AMR in sensitized recipients.
  • Current desensitization and induction protocols, including imlifidase, do not fully prevent AMR.

Purpose of the Study:

  • To evaluate advanced diagnostic methods for early detection of AMR in HLA-i kidney transplantation.
  • To explore the utility of transcriptomics and non-invasive biomarkers for monitoring rejection.
  • To emphasize a multimodal approach for timely intervention and prevention of chronic damage.

Main Methods:

  • Utilized tissue-based transcriptomics, specifically the Molecular Microscope Diagnostic system (MMDx) and Banff Human Organ Transplant gene panel (B-HOT).
  • Assessed plasma donor-derived cell-free DNA (dd-cfDNA) as a non-invasive biomarker.
  • Integrated histology, DSA monitoring, transcriptomics, and biomarkers for AMR phenotyping.

Main Results:

  • Transcriptomics (MMDx, B-HOT) offer enhanced sensitivity for detecting molecular AMR phenotypes preceding morphologic changes.
  • Plasma dd-cfDNA correlates with molecular rejection activity, aiding longitudinal monitoring in high-risk patients.
  • Early detection of subclinical injury is possible through multimodal diagnostics.

Conclusions:

  • Advanced transcriptomic profiling and non-invasive biomarkers improve early AMR detection in HLA-i kidney transplants.
  • A multimodal diagnostic approach is critical for timely intervention and preventing chronic transplant glomerulopathy.
  • These methods are particularly valuable in sensitized recipients to manage AMR effectively.