Aseem Kumar Tiwari: The Molecular Dimension of HLA Matching
Aseem Kumar Tiwari, Senior Director at Medanta Hospital (Gurgaon), shared a post on LinkedIn about a recent article he and his colleagues co-authored, published in Expert Review of Clinical Immunology, adding:
“In kidney transplantation, donor–recipient immunological compatibility is currently assessed using a combination of HLA typing, donor-specific antibody (DSA) testing (commonly performed using solid-phase assays such as Luminex), and crossmatching, including flow cytometric crossmatch.
While these approaches remain central to clinical decision-making, conventional antigen-level HLA matching may not fully capture the molecular differences that influence alloimmune responses.
Eplet mismatch analysis offers a more granular, molecular-level assessment of HLA compatibility. Evidence suggests that higher eplet mismatch burdens, particularly at HLA-DQ and other class II loci, are associated with an increased risk of de novo DSA development, antibody-mediated rejection, and adverse graft outcomes.
This approach may therefore complement conventional compatibility testing by refining immunological risk stratification and supporting more individualised post-transplant surveillance.
However, eplet mismatch analysis is not yet an established standard of care and should not replace DSA testing or conventional crossmatching. Variability among analytical algorithms, differences in HLA typing resolution, and the absence of universally validated clinical thresholds remain important limitations.
Its potential application in deceased-donor transplantation is particularly worth exploring, where time-sensitive organ allocation creates challenges in comprehensive immunological risk assessment.
Our recently published review from Medanta critically examines the available evidence, current limitations, and future prospects of molecular HLA matching.
It aims to stimulate scientific discussion on how eplet mismatch analysis might complement established compatibility assessment and contribute to more individualised donor–recipient selection and transplant management, pending further clinical validation.”
Title: Molecular HLA matching in kidney transplantation: the emerging role of eplet mismatch analysis
Authors: Simmi Mehra, Rajni Chauhan, Aseem Kumar Tiwari, Vyas M. Shingatgeri, Gunjan Bhardwaj, Shubham Gupta, Simran Kahlon, Punit Kumar
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