HISTOCOMPATIBILITY: Edited by Stanislaw StepkowskiHow the definition of acceptable antigens and epitope analysis can facilitate transplantation of highly sensitized patients with excellent long-term graft survivalHeidt, Sebastiaan; Haasnoot, Geert W.; Claas, Frans H.J.Author Information Eurotransplant Reference Laboratory, Leiden University Medical Center, Leiden, The Netherlands Correspondence to Sebastiaan Heidt, Eurotransplant Reference Laboratory, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. E-mail: [email protected] Current Opinion in Organ Transplantation: August 2018 - Volume 23 - Issue 4 - p 493-499 doi: 10.1097/MOT.0000000000000545 Buy Metrics Abstract Purpose of review Highly sensitized patients awaiting a renal transplant have a low chance of receiving an organ offer. Defining acceptable antigens and using this information for allocation purposes can vastly enhance transplantation of this subgroup of patients, which is the essence of the Eurotransplant Acceptable Mismatch program. Acceptable antigens can be determined by extensive laboratory testing, as well as on basis of human leukocyte antigen (HLA) epitope analyses. Recent findings Within the Acceptable Mismatch program, there is no effect of HLA mismatches on long-term graft survival. Furthermore, patients transplanted through the Acceptable Mismatch program have similar long-term graft survival to nonsensitized patients transplanted through regular allocation. Although HLA epitope analysis is already being used for defining acceptable HLA antigens for highly sensitized patients in the Acceptable Mismatch program, increasing knowledge on HLA antibody – epitope interactions will pave the way toward the definition of acceptable epitopes for highly sensitized patients in the future. Summary Allocation based on acceptable antigens can facilitate transplantation of highly sensitized patients with excellent long-term graft survival. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.