Detection of donor-specific antibodies in kidney transplantation.

INTRODUCTION: Precise and timely detection of human leukocyte antigen (HLA) donor-specific antibodies (DSAs) is vital for evaluating humoral immune status of patients pre- and post-transplantation. SOURCE OF DATA: Clinically relevant articles on theory, development, methodology and application of HLA-DSA testing in kidney transplantation. AREAS OF AGREEMENT AND CONTROVERSY: The availability of solid phase HLA-antibody testing revolutionized our ability to detect HLA-DSA and to appreciate their significance in kidney transplant outcome. The best approach to determine the strength, immunogenicity and pathogenicity of HLA antibodies still remains controversial. GROWING POINTS: Assays to identify complement-binding antibodies were developed. Their clinical utilization, pre- and post-transplantation, is currently under investigation. Appreciation of the complexity of HLA-DQ antibodies should lead to better assignment of unacceptable antibodies and cPRA calculation. AREAS TIMELY FOR DEVELOPING RESEARCH: Characterization of HLA-antibody epitopes, and utilization of epitope matching to better define compatible donors could contribute to better transplant outcomes.