Frontiers in Medicine· 2026Q1
HLA molecular mismatch – A step towards precision medicine in transplantation for individualized immune risk assessment and immunosuppression
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- Q1SCImago
- 2026year
Short summary
HLA molecular mismatch is emerging as a prognostic biomarker for alloimmune risk in kidney transplantation, linking to antibody development, rejection, and graft outcomes.
AI-generated from the title and abstract; the full text is not read.
Key points
- Late kidney allograft attrition is a major challenge, with alloimmune injury a key cause of graft failure.
- HLA molecular mismatch is an emerging prognostic biomarker for alloimmune risk in transplantation.
- Molecular mismatch is linked to de novo donor-specific antibody development, rejection, and graft outcomes.
- Potential applications include immunosuppression minimization and risk-adapted surveillance, but intervention guidance requires more evidence.
AI-generated from the title and abstract; the full text is not read.
Abstract
Despite advances in immunosuppression and histocompatibility assessment, late kidney allograft attrition remains an important challenge, with alloimmune injury a major cause of death-censored graft failure. More precise assessment of alloimmune risk could enable individualized immunosuppression and surveillance based on recipient risk. In this narrative review, we examine the evolution of histocompatibility assessment and the emergence of HLA molecular mismatch as a prognostic biomarker of alloimmunity. We review evidence linking molecular mismatch to de novo donor-specific antibody development, rejection and graft outcomes, and its interaction with immunosuppressive exposure. We critically evaluate potential applications to immunosuppression minimization, risk-adapted surveillance, and donor selection, while distinguishing prognostic validity from evidence for mismatch-guided intervention. Finally, we discuss methodological and biological limitations and emerging approaches integrating complementary molecular compatibility measures with functional and longitudinal biomarkers. Such multimodal strategies may ultimately enable more individualized assessment and management of alloimmune risk following kidney transplantation.
The authors' abstract, as published at the source. Frontiers in Medicine, 2026 · DOI ↗
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Field: Transplantation
TransplantationMedicine