De Novo Donor-Specific Anti-HLA Antibody Risk Stratification in Kidney Transplantation Using a Combination of B Cell and T Cell Molecular Mismatch Assessment

·  De novo donor-specific antibodies (dnDSA) negatively impact kidney transplant outcomes.

·  Molecular HLA mismatch assessment, using algorithms like Snow, HLAMatchmaker, and PIRCHE-II, provides a more precise way to evaluate immunological risk.

·  Increased B cell and T cell epitope mismatches, particularly at HLA Class I and DRB1/DQB1 loci, are strongly associated with dnDSA development.

·  Combining B cell and T cell epitope mismatch scores improves risk stratification and may be useful in donor selection to optimize transplant success.

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