Using HLA antibody detection, monitoring, and treatment to improve long-term allograft survival.

The evidence supporting HLA antibodies as a biomarker in transplant is substantial. It is becoming more clear that these patients represent a new phenotype of patient that is at the highest risk to rapidly progress to chronic damage. Therefore early detection of these high risk patients through serial screening is necessary. Additionally, once patients develop DSA positivity, IgG subclass testing may indicate how eminent his/her graft failure ensue. Moving forward, we should focus monitoring and treating at first detection of persistent antibodies. This may be the only reasonable way to have significant impact on long-term allograft survival.