{
  "abstract": "Despite advances in immunosuppression and histocompatibility assessment, late kidney allograft attrition remains an important challenge, with alloimmune injury a major cause of death-censored graft failure. More precise assessment of alloimmune risk could enable individualized immunosuppression and surveillance based on recipient risk. In this narrative review, we examine the evolution of histocompatibility assessment and the emergence of HLA molecular mismatch as a prognostic biomarker of alloimmunity. We review evidence linking molecular mismatch to de novo donor-specific antibody development, rejection and graft outcomes, and its interaction with immunosuppressive exposure. We critically evaluate potential applications to immunosuppression minimization, risk-adapted surveillance, and donor selection, while distinguishing prognostic validity from evidence for mismatch-guided intervention. Finally, we discuss methodological and biological limitations and emerging approaches integrating complementary molecular compatibility measures with functional and longitudinal biomarkers. Such multimodal strategies may ultimately enable more individualized assessment and management of alloimmune risk following kidney transplantation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Medicine, National University Hospital, Singapore, Singapore",
    "Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore",
    "National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Christine Jia Yu Wong"
    },
    {
      "affs": [
        0
      ],
      "name": "Emmett Tsz Yeung Wong"
    },
    {
      "affs": [
        1
      ],
      "name": "Emmett Tsz Yeung Wong"
    },
    {
      "affs": [
        2
      ],
      "name": "Emmett Tsz Yeung Wong"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/66p6xrj98747s.bib",
  "cited_by": 0,
  "doi": "10.3389/fmed.2026.1990225",
  "fulltext_url": "https://www.frontiersin.org/articles/10.3389/fmed.2026.1990225/full",
  "id": "66p6xrj98747s",
  "issns": [
    "2296-858X"
  ],
  "landing_url": "https://doi.org/10.3389/fmed.2026.1990225",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "R5-920"
    ],
    [
      "openalex",
      "2747|Renal Transplantation Outcomes and Treatments"
    ]
  ],
  "openalex": "W7223326337",
  "pdf_url": "https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2026.1990225/pdf",
  "pmcid": "PMC13740249",
  "pmid": "42996804",
  "published": "2026-10-23",
  "publisher": "Frontiers Media S.A.",
  "ris": "https://research.draconitic.com/paper/66p6xrj98747s.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:43:56Z",
      "native_id": "7f959f4db69344fcbd28bdbbecda906b",
      "source": "doaj",
      "url": "https://doi.org/10.3389/fmed.2026.1990225"
    },
    {
      "first_seen": "2026-11-09T15:20:41Z",
      "native_id": "MED:42996804",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42996804"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2747|Renal Transplantation Outcomes and Treatments",
      "subfield": "surgery"
    }
  ],
  "title": "HLA molecular mismatch – A step towards precision medicine in transplantation for individualized immune risk assessment and immunosuppression",
  "title_text": "HLA molecular mismatch – A step towards precision medicine in transplantation for individualized immune risk assessment and immunosuppression",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:41Z",
  "url": "https://research.draconitic.com/paper/66p6xrj98747s",
  "venue": "Frontiers in Medicine",
  "versions": []
}