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Acceptable mismatching at the class II epitope level: the Canadian experience

Wiebe, Chrisa; Nickerson, Petera,b

Current Opinion in Organ Transplantation: August 2014 - Volume 19 - Issue 4 - p 442–446
doi: 10.1097/MOT.0000000000000104
HISTOCOMPATIBILITY: Edited by RenÉ J. Duquesnoy

Purpose of review To summarize the evidence concerning human leukocyte antigen (HLA) epitope mismatch analysis as a means to predict donor-specific antibody (DSA) development and allograft survival.

Recent findings HLA epitope mismatch analysis outperforms traditional whole molecule antigen mismatch for predicting the risk of de-novo DSA development. By analyzing the number of epitope mismatches for a given donor-recipient pair, thresholds have been identified to stratify patients into those at high or low risk of de-novo DSA development. Epitope specificity assignment in patients who develop de-novo DSA compared with controls who do not provides an opportunity to study the relative immunogenicity of mismatched HLA epitopes.

Summary Recognizing that de-novo DSA is a major cause of graft loss, HLA epitope mismatch analysis is a strategy to minimize de-novo DSA development and improve long-term graft survival.

aDepartment of Medicine and Immunology, University of Manitoba

bDiagnostic Services of Manitoba, Winnipeg, Manitoba, Canada

Correspondence to Peter Nickerson, Canadian Blood Services Building, 312-777 William Avenue, Winnipeg, Manitoba R3E 3R4, Canada. Tel: +1 204 789 1025; fax +1 204 789 3942; e-mail:

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