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Should We Revisit HLA Matching to Improve Long-Term Graft Outcomes?

  • Kidney Transplantation (M Henry and R Pelletier, Section Editors)
  • Published:
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Abstract

Purpose of Review

We present here an overview of the needs and requirements for human leukocyte antigen (HLA) matching, explain and explore the potential benefits of epitope matching, and discuss the benefits of allele-level high-resolution matching at all HLA loci, i.e. HLA-A, -B, -DR, -DQ and -DP, for donor selection needs during renal transplantation.

Recent Findings

Donor recipient HLA matching has a substantial impact on organ transplantation by prolonging graft survival, minimizing rejection episodes, preventing sensitization, providing a better chance for retransplantation and reducing the percentage of deaths due to graft dysfunction. Despite these advantages, the utility of HLA matching has been challenged, mainly because of the availability of highly effective immunosuppressive agents clubbed with steady improvements in short-term graft survival. Moreover, the risk associated with prolonged periods on dialysis while waiting for an optimally matched donor is minimized.

Summary

There is a need to strike a balance between the benefits of HLA matching and problems associated with finding such a donor. A more viable alternative would be to find a donor with mismatches having a low probability of inducing humoral responses.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Opelz G. Impact of HLA compatibility on survival of kidney transplants from unrelated live donors. Transplantation. 1997;64(10):1473–5.

    Article  PubMed  CAS  Google Scholar 

  2. Takemoto S, Terasaki P, Gjertson D, Cecka J. Twelve years' experience with national sharing of HLA-matched cadaveric kidneys for transplantation. N Engl J Med. 2000;343(15):1078–84.

    Article  PubMed  CAS  Google Scholar 

  3. Opelz G, Döhler B. Effect of human leukocyte antigen compatibility on kidney graft survival: comparative analysis of two decades. Transplantation. 2007;84(2):137–43.

    Article  PubMed  CAS  Google Scholar 

  4. Dunn T, Noreen H, Gillingham K, Maurer D, Goruroglu Ozturk O, Pruett TL, et al. Revisiting Traditional Risk Factors for Rejection and Graft Loss After Kidney Transplantation. Am J Transplant. 2011;11(10):2132–43.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Opelz G, Döhler B, Middleton D, Süsal C. HLA Matching in Pediatric Kidney Transplantation: HLA Poorly Matched Living Donor Transplants Versus HLA Well-Matched Deceased Donor Transplants. Transplantation. 2017;101(11):2789–92.

    Article  PubMed  Google Scholar 

  6. Süsal C, Opelz G. Current role of human leukocyte antigen matching in kidney transplantation. Curr Opin Organ Transplant. 2013;18(4):438–44.

    Article  PubMed  CAS  Google Scholar 

  7. Wissing K, Fomegné G, Broeders N, Ghisdal L, Hoang AD, Mikhalski D, et al. HLA mismatches remain risk factors for acute kidney allograft rejection in patients receiving quadruple immunosuppression with anti-interleukin-2 receptor antibodies. Transplantation. 2008;85(3):411–6.

    Article  PubMed  CAS  Google Scholar 

  8. •• Williams RC, Opelz G, McGarvey CJ, Weil EJ, Chakkera HA. The risk of transplant failure with HLA mismatch in first adult kidney allografts from deceased donors. Transplantation. 2016;100:1094–102. This study in a large cohort of adult renal allograft recipients from deceased donors demonstrates a significant linear relationship between hazard ratios and HLA mismatch, which continues to affect allograft survival even during the recent period of increasing success in renal transplantation.

    Article  PubMed  CAS  Google Scholar 

  9. Brugière O, Thabut G, Suberbielle C, Reynaud-Gaubert M, Thomas P, Pison C, et al. Relative impact of human leukocyte antigen mismatching and graft ischemic time after lung transplantation. J Heart Lung Transplant. 2008;27:628–34.

    Article  PubMed  Google Scholar 

  10. Yamada Y, Langner T, Inci I, Benden C, Schuurmans M, Weder W, et al. Impact of human leukocyte antigen mismatch on lung transplant outcome. Interact Cardiovasc Thorac Surg. 2018;1–6.

  11. Ansari D, Bucin D, Nilsson J. Human leukocyte antigen matching in heart transplantation: systematic review and meta-analysis. Transpl Int. 2014;8:793–804.

    Article  Google Scholar 

  12. Ginde S, Ellis TM, Nugent M, Simpson P, Stendahl G, Berger S, et al. The Influence of Human Leukocyte Antigen Matching on Outcomes in Pediatric Heart Transplantation. Pediatr Cardiol. 2014;35(6):1020–3.

    Article  PubMed  Google Scholar 

  13. Rudolph EN, Dunn TB, Mauer D, Noreen H, Sutherland DER, Kandaswamy R, et al. HLA-A, -B, -C, -DR, and -DQ matching in pancreas transplantation: effect on graft rejection and survival. Am J Transplant. 2016;16(8):2401–12.

    Article  PubMed  CAS  Google Scholar 

  14. Badawy A, Kaido T, Yoshizawa A, Yagi S, Fukumitsu K, Okajima H, et al. HLA compatibility and lymphocyte cross-matching play no significant role in the current adult-to-adult living donor liver transplantation. Clin Transplant. 2018;32(4):e13234. https://doi.org/10.1111/ctr.13234.

    Article  PubMed  CAS  Google Scholar 

  15. Yacoub R, Nadkarni GN, Cravedi P, He JC, Delaney VB, Kent R, et al. Analysis of OPTN/UNOS registry suggests the number of HLA matches and not mismatches is a stronger independent predictor of kidney transplant survival. Kidney Int. 2018;93(2):482–90.

    Article  PubMed  Google Scholar 

  16. Oberbarnscheidt MH, Zeng Q, Li Q, Dai H, Williams AL, Shlomchik WD, et al. Non-self recognition by monocytes initiates allograft rejection. J Clin Invest. 2014;124:3579–89.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Sankaran D, Asderakis A, Ashraf S, Roberts IS, Short CD, Dyer PA, et al. Cytokine gene polymorphisms predict acute graft rejection following renal transplantation. Kidney Int. 1999;56:281–8.

    Article  PubMed  CAS  Google Scholar 

  18. Tinckam K, Rush D, Hutchinson I, Dembinski I, Pravica V, Jeffery J, et al. The relative importance of cytokine gene polymorphisms in the development of early and late acute rejection and six-month renal allograft pathology. Transplantation. 2005;79:836–41.

    Article  PubMed  CAS  Google Scholar 

  19. Lim WH, Chapman JR, Coates PT, Lewis JR, Russ GR, Watson N, et al. HLA-DQ mismatches and rejection in kidney transplant recipients. Clin J Am Soc Nephrol. 2016;11:875–83.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Sarabu N, Hricik DE. HLA-DQ mismatching: mounting evidence for a role in kidney transplant rejection. Clin J Am Soc Nephrol. 2016;11:759–60.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Meier-Kriesche HU, Scornik JC, Susskind B, Rehman S. Schold JD. A lifetime versus a graft life approach redefines the importance of HLA matching in kidney transplant patients. Transplantation. 2009;88(1):23–9.

    Article  PubMed  Google Scholar 

  22. Gralla J, Tong S, Wiseman AC. The impact of human leukocyte antigen mismatching on sensitization rates and subsequent retransplantation after first graft failure in pediatric renal transplant recipients. Transplantation. 2013;95(10):1218–24.

    Article  PubMed  CAS  Google Scholar 

  23. Opelz G, Döhler B. Association of HLA mismatch with death with a functioning graft after kidney transplantation: a collaborative transplant study report. Am J Transplant. 2012;12(11):3031–8.

    Article  PubMed  CAS  Google Scholar 

  24. Opelz G, Döhler B. Impact of HLA mismatching on incidence of posttransplant non Hodgkin lymphoma after kidney transplantation. Transplantation. 2010;89:567–72.

    Article  PubMed  CAS  Google Scholar 

  25. Wiebe C, Gibson IW, Blydt-Hansen TD, Karpinski M, Ho J, Storsley LJ, et al. Evolution and clinical pathologic correlations of de novo donor-specific HLA antibody post kidney transplant. Am J Transplant. 2012;12:1157–67.

    Article  PubMed  CAS  Google Scholar 

  26. Liefeldt L, Brakemeier S, Glander P, Waiser J, Lachmann N, Schönemann C, et al. Donor-specific HLA antibodies in a cohort comparing everolimus with cyclosporine after kidney transplantation. Am J Transplant. 2012;12(5):1192–8.

    Article  PubMed  CAS  Google Scholar 

  27. Everly MJ, Rebellato LM, Haisch CE, Ozawa M, Parker K, Briley KP, et al. Incidence and impact of de novo donor-specific alloantibody in primary renal allografts. Transplantation. 2013;95(3):410–7.

    Article  PubMed  CAS  Google Scholar 

  28. Hidalgo LG, Campbell PM, Sis B, Einecke G, Mengel M, Chang J, et al. De novo donor specific antibody at the time of kidney transplant biopsy associates with microvascular pathology and late graft failure. Am J Transplant. 2009;9(11):2532–41.

    Article  PubMed  CAS  Google Scholar 

  29. Cooper JE, Gralla J, Cagle L, Goldberg R, Chan L, Wiseman AC. Inferior kidney allograft outcomes in patients with de novo donor-specific antibodies are due to acute rejection episodes. Transplantation. 2011;91(10):1103–9.

    Article  PubMed  CAS  Google Scholar 

  30. Willicombe M, Brookes P, Sergeant R, Santos-Nunez E, Steggar C, Galliford J, et al. De novo DQ donor-specific antibodies are associated with a significant risk of antibody-mediated rejection and transplant glomerulopathy. Transplantation. 2012;94(2):172–7.

    Article  PubMed  CAS  Google Scholar 

  31. Kim JJ, Balasubramanian R, Michaelides G, Wittenhagen P, Sebire NJ, Mamode N, et al. The clinical spectrum of de novo donor-specific antibodies in pediatric renal transplant recipients. Am J Transplant. 2014;14:2350–8.

    Article  PubMed  CAS  Google Scholar 

  32. DeVos JM, Gaber AO, Teeter LD, Graviss EA, Patel SJ, Land GA, et al. Intermediate-term graft loss after renal transplantation is associated with both donor specific antibody and acute rejection. Transplantation. 2014;97(5):534–40.

    Article  PubMed  CAS  Google Scholar 

  33. Eskandary F, Bond G, Kozakowski N, Regele H, Marinova L, Wahrmann M, et al. Diagnostic contribution of donor-specific antibody characteristics to uncover late silent antibody-mediated rejection-results of a cross-sectional screening study. Transplantation. 2017;101(3):631–41.

    Article  PubMed  CAS  Google Scholar 

  34. Cicciarelli JC, Lemp NA, Chang Y, Koss M, Hacke K, Kasahara N, et al. Renal Transplant Patients Biopsied for Cause and Tested for C4d, DSA, and IgG Subclasses and C1q: Which Humoral Markers Improve Diagnosis and Outcomes? J Immunol Res. 2017;2017:1652931.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. Mehra NK, Rajalingam R, Giphart MJ. Generation of DR51-associated DQA1, DQB1 haplotypes in Asian Indians. Tissue Antigens. 1996;47(1):85–9.

    Article  PubMed  CAS  Google Scholar 

  36. Van Regenmortel M. Reductionism and the search for structure–function relationships in antibody molecules. J Mol Recognit. 2002;15:240–7.

    Article  PubMed  CAS  Google Scholar 

  37. • Duquesnoy RJ. HLA epitope based matching for transplantation. Transplant Immunol. 2014;31:1–6. In this excellent review, the author, the preeminent scientist who pioneered the eplet concept of HLA antibody recognition, explains the structural concept of epitopes and addresses the relevance of determining epitope specificities of HLA antibodies, the effect of epitope structure on technique-dependent antibody reactivity, identification of acceptable mismatches for sensitized patients, epitope loads of mismatched antigens and the recently developed “nonself–self” paradigm of epitope immunogenicity.

    Article  CAS  Google Scholar 

  38. • Sypek MP, Hughes P, Kausman JY. HLA epitope matching in pediatric renal transplantation. Pediatr Nephrol. 2017;32(10):1861–9. In this comprehensive review, the authors explain paratope–epitope interactions in very lucid and simple language, addressing the importance and clinical relevance of epitope-based tissue matching in pediatric renal transplantation and the challenges associated with HLA epitope matching.

    Article  PubMed  Google Scholar 

  39. Duquesnoy RJ. HLAMatchmaker: A molecularly based algorithm for histocompatibility determination. I. Description of the algorithm. Hum Immunol. 2002;63:339–52.

    Article  PubMed  CAS  Google Scholar 

  40. Duquesnoy RJ. Structurally based approach to determine HLA compatibility at the humoral immune level. Hum Immunol. 2006;67:847–62.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  41. El-Awar N, Lee JH, Tarsitani C, Terasaki PI. HLA class I epitopes: recognition of binding sites by mAbs or eluted alloantibody confirmed with single recombinant antigens. Hum. Immunol. 2007;68:170–80.

    Article  PubMed  CAS  Google Scholar 

  42. Kosmoliaptsis V, Chaudhry AN, Sharples LD, Halsall DJ, Dafforn TR, Bradley JA, et al. Predicting HLA class I alloantigen immunogenicity from the number and physiochemical properties of amino acid polymorphisms. Transplantation. 2009;88:791–8.

    Article  PubMed  CAS  Google Scholar 

  43. Kosmoliaptsis V, Sharples LD, Chaudhry AN, Halsall DJ, Bradley JA, Taylor CJ. Predicting HLA class II alloantigen immunogenicity from the number and physiochemical properties of amino acid polymorphisms. Transplantation. 2011;91:183–90.

    Article  PubMed  CAS  Google Scholar 

  44. • Kosmoliaptsis V, Mallon DH, Chen Y, Bolton EM, Bradley AJ, Taylor CJ. Alloantibody responses after renal transplant failure can be better predicted by donor–recipient HLA amino acid sequence and physicochemical disparities than conventional HLA matching. Am J Transplant. 2016;16:2139–47. This study assessed the prediction of donor HLA immunogenicity based on amino acid mismatch score (AMS), eplet mismatch score (EpMS) and electrostatic mismatch score (EMS). AMS and EMS were found to be superior to conventional HLA matching in the prediction of HLA allosensitization.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Wiebe C, Pochinco D, Blydt-Hansen TD, Ho J, Birk PE, Karpinski M, et al. Class II HLA epitope matching-A strategy to minimize de novo donor-specific antibody development and improve outcomes. Am J Transplant. 2013;13:3114–22.

    Article  PubMed  CAS  Google Scholar 

  46. Otten HG, Calis JJ, Kesmir C, van Zuilen AD, Spierings E. Predicted indirectly recognizable HLA epitopes presented by HLA-DR correlate with the de novo development of donor-specific HLA IgG antibodies after kidney transplantation. Hum Immunol. 2013;74:290–6.

    Article  PubMed  CAS  Google Scholar 

  47. Sapir-Pichhadze R, Tinckam K, Quach K, Logan AG, Laupacis A, John R, et al. HLA-DR and -DQ eplet mismatches and transplant glomerulopathy: A nested case-control study. Am J Transplant. 2015;15:137–48.

    Article  PubMed  CAS  Google Scholar 

  48. • Do Nguyen HT, Wong G, Chapman JR, McDonald SP, Coates PT, Watson N, et al. The Association Between Broad Antigen HLA Mismatches, Eplet HLA Mismatches and Acute Rejection After Kidney Transplantation. Transplant Direct. 2016;2(12):e120. This registry population-based cohort study investigates the association between eplet mismatches, broad antigen mismatches and acute rejection in renal allograft recipients. In recipients with low immunological risk (0–2 broad antigen HLA-ABDR mismatch), those with a higher number of eplet mismatches (≥20) experienced a greater risk of rejection than those with < 20 mismatches.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  49. Wiebe C, Nevins TE, Robiner WN, Thomas W, Matas AJ, Nickerson PW. The synergistic effect of class II HLA epitope-mismatch and nonadherence on acute rejection and graft survival. Am J Transplant. 2015;15:2197–202.

    Article  PubMed  CAS  Google Scholar 

  50. Singh P, Filippone EJ, Colombe BW, Shah AP, Zhan T, Harach M, et al. Sensitization trends after renal allograft failure: the role of DQ eplet mismatches in becoming highly sensitized. Clin Transplant. 2016;30:71–80.

    Article  PubMed  CAS  Google Scholar 

  51. Lachmann N, Niemann M, Reinke P, Budde K, Schmidt D, Halleck F, et al. Donor recipient matching based on predicted recognizable HLA epitopes predicts the incidence of de novo donor-specific HLA antibodies following renal transplantation. Am J Transplant. 2017;17(12):3076–86.

    Article  PubMed  CAS  Google Scholar 

  52. Geneugelijk K, Niemann M, Drylewicz J, van Zuilen AD, Joosten I, Allebes WA, et al. PIRCHE-II Is Related to Graft Failure after Kidney Transplantation. Front Immunol. 2018;9:321. https://doi.org/10.3389/fimmu.2018.00321.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Willicombe M, Blow M, Santos-Nunez E, Freeman C, Brookes P, Taube D. Terasaki epitope mismatch burden predicts the development of de novo DQ donor specific antibodies and are associated with adverse allograft outcomes. Transplantation. 2018;102(1):127–34.

    Article  PubMed  Google Scholar 

  54. Walton DC, Hiho SJ, Cantwell LS, Diviney MB, Wright ST, Snell GI, et al. HLA matching at the eplet level protects against chronic lung allograft dysfunction. Am J Transplant. 2016;16:2695–703.

    Article  PubMed  CAS  Google Scholar 

  55. Sullivan PM, Warner P, Kemna MS, Albers EL, Law SP, Weiss NS, et al. HLA molecular epitope mismatching and long term graft loss in pediatric heart transplant recipients. J Heart Lung Transplant. 2015;34:950–7.

    Article  PubMed  Google Scholar 

  56. •• Wiebe C, Kosmoliaptsis V, Pochinco D, Taylor C, Nickerson P. A Comparison of HLA Molecular Mismatch Methods to Determine HLA Immunogenicity. Transplantation. 2018; https://doi.org/10.1097/TP.0000000000002117. This study compared three approaches—amino acid, eplet and electrostatic mismatch—for determining molecular mismatch between renal allograft recipients and their respective donors in order to assess the risk of de novo development of class II DSA. All three methods correlated significantly with de novo DSA development on multivariate analysis after adjusting for recipient age, baseline immunosuppression and nonadherence. No advantage was found in the use of one approach over another.

  57. Bryan CF, Luger AM, Smith JL, Warady BA, Wakefield M, Schadde E, et al. Sharing kidneys across donor-service area boundaries with sensitized candidates can be influenced by HLA C. Clin Transplant. 2010;24:56–61.

    Article  PubMed  Google Scholar 

  58. Ling M, Marfo K, Masiakos P, Aljanabi A, Lindower J, Glicklich D, et al. Pretransplant anti-HLA-Cw and anti-HLADP antibodies in sensitized patients. Hum Immunol. 2012;73:879–83.

    Article  PubMed  CAS  Google Scholar 

  59. Lopes D, Barra T, Malheiro J, Tafulo S, Martins L, Almeida M, et al. Effect of Different Sensitization Events on HLA Alloimmunization in Kidney Transplantation Candidates. Transplant Proc. 2015;47(4):894–7.

    Article  PubMed  CAS  Google Scholar 

  60. Bachelet T, Couzi L, Guidicelli G, Moreau K, Morel D, Merville P, et al. Anti-Cw donor-specific alloantibodies can lead to positive flow cytometry crossmatch and irreversible acute antibody-mediated rejection. Am J Transplant. 2011;11:1543–4.

    Article  PubMed  CAS  Google Scholar 

  61. Rogers NM, Bennett GD, Toby Coates P. Transplant glomerulopathy and rapid allograft loss in the presence of HLA-Cw7 antibodies. Transpl Int. 2012;25(3):e38–40.

    Article  PubMed  Google Scholar 

  62. Aubert O, Bories MC, Suberbielle C, Snanoudj R, Anglicheau D, Rabant M, et al. Risk of antibody-mediated rejection in kidney transplant recipients with anti-HLA-C donor-specific antibodies. Am J Transplant. 2014;14:1439–45.

    Article  PubMed  CAS  Google Scholar 

  63. Bachelet T, Martinez C, Del Bello A, Couzi L, Kejji S, Guidicelli G, et al. Deleterious Impact of Donor-Specific Anti-HLA Antibodies Toward HLA-Cw and HLA-DP in Kidney Transplantation. Transplantation. 2016;100:159–66.

    Article  PubMed  CAS  Google Scholar 

  64. Santos S, Malheiro J, Tafulo S, Dias L, Carmo R, Sampaio S, et al. Impact of preformed donor-specific antibodies against HLA class I on kidney graft outcomes: Comparative analysis of exclusively anti-Cw vs anti-A and/or -B antibodies. World J Transplant. 2016;6(4):689–96.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Walsh RC, Brailey P, Girnita A, Alloway RR, Shields AR, Wall GE, et al. Early and late acute antibody mediated rejection differ immunologically and in response to proteasome inhibition. Transplantation. 2011;91:1218–26.

    Article  PubMed  CAS  Google Scholar 

  66. Freedman BI, Thacker LR, Heise ER, Adams PL. HLA-DQ matching in cadaveric renal transplantation. Clin Transplant. 1997;11:480–4.

    PubMed  CAS  Google Scholar 

  67. Sasaki N, Idica A. The HLA-matching effect in different cohorts of kidney transplant recipients: 10 years later. Clin Transpl. 2010;2010:261–82.

    Google Scholar 

  68. Tambur AR, Leventhal JR, Zitzner JR, Walsh RC, Friedewald JJ. The DQ barrier: improving organ allocation equity using HLA-DQ information. Transplantation. 2013;95(4):635–40.

    Article  PubMed  Google Scholar 

  69. Thaunat O, Hanf W, Dubois V, McGregor B, Perrat G, Chauvet C, et al. Chronic humoral rejection mediated by anti-HLA-DP alloantibodies: insights into the role of epitope sharing in donor-specific and non-donor specific alloantibodies generation. Transpl Immunol. 2009;20(4):209–11.

    Article  PubMed  CAS  Google Scholar 

  70. Singh P, Colombe BW, Francos GC, Martinez Cantarin MP, Frank AM. Acute humoral rejection in a zero-mismatch deceased donor renal transplant due to an antibody to an HLA-DP alpha. Transplantation. 2010;90(2):220–1.

    Article  PubMed  Google Scholar 

  71. Gilbert M, Paul S, Perrat G, Giannoli C, Pouteil Noble C, et al. Impact of pretransplant human leukocyte antigen-C and -DP antibodies on kidney graft outcome. Transplant Proc. 2011;43:3412–4.

    Article  PubMed  CAS  Google Scholar 

  72. Callender CJ, Fernandez-Vina M, Leffell MS, Zachary AA. Frequency of HLA-DP-specific antibodies and a possible new cross-reacting group. Hum Immunol. 2012;73:175–9.

    Article  PubMed  CAS  Google Scholar 

  73. Jolly EC, Key T, Rasheed H, et al. Preformed donor HLA-DP-specific antibodies mediate acute and chronic antibody-mediated rejection following renal transplantation. Am J Transplant. 2012;12(10):2845–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  74. • Zachary AA, Leffell MS. HLA Mismatching Strategies for Solid Organ Transplantation – A Balancing Act. Front Immunol. 2016;7:575. https://doi.org/10.3389/fimmu.2016.00575. This review provides very balanced insight into strategies for HLA mismatching in solid organ transplantation.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  75. Duquesnoy RJ, Kamoun M, Baxter-Lowe LA, Woodle ES, Bray RA, Claas FHJ, et al. Should HLA Mismatch Acceptability for Sensitized Transplant Candidates Be Determined at the High-Resolution Rather Than the Antigen Level? Am J Transplant. 2015;15:923–30.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pathology, Command Hospital (SC), Pune, 411040, India

    Ajay Kumar Baranwal

  2. Clinical Reference Laboratory, SRL Ltd., GP-26, Maruti Industrial Estate, Udyog Vihar, Sector-18, Gurgaon, India

    Yoginder Pal Singh

  3. National Chair & Former Dean (R), All India Institute of Medical Sciences, New Delhi, India

    Narinder K. Mehra

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  1. Ajay Kumar Baranwal
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  2. Yoginder Pal Singh
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Correspondence to Ajay Kumar Baranwal.

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Ajay Kumar Baranwal, Yoginder Pal Singh, and Narinder Mehra declare that they have no conflict of interest.

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Baranwal, A.K., Singh, Y.P. & Mehra, N.K. Should We Revisit HLA Matching to Improve Long-Term Graft Outcomes?. Curr Transpl Rep 5, 235–243 (2018). https://doi.org/10.1007/s40472-018-0201-1

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