The detection of anti-HLA antibodies and donor-specific anti-HLA antibodies, is an important part of the immune risk assessment, donor-recipient serological histocompatibility evaluation (cross-match) and deceased donor organ allocation. Alloantibodies can be pre-formed, that is, present before transplantation as a consequence of previous alloimmunisations or through the phenomenon of cross reaction. Alternatively, these alloantibodies can be formed de novo as a consequence of allostimulation by the HLA mismatches as discussed above. Both pre-formed and de novo anti HLA antibodies, especially if directed to the donor, and worse if able to fix complement, associate with the risk of antibody-mediated rejection and reduced transplant survival.
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