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Eplet mismatch imputation studies should include immunologic risk assessment

HLA eplet mismatch analysis represents the evolution from antigen-level match assessments and cell-based donor-specific antibody (DSA) identification to an integrated approach combining sophisticated molecular histocompatibility genotyping with solid phase antibody detection techniques. Analyzing eplet mismatches between donor-recipient pairs at each HLA locus and using eplet motifs in the interpretation of post-transplant antibody reactivity has garnered increasing attention in recent years. Seminal studies to date reveal a direct correlation between post-transplant outcomes and the degree of HLA-DR and/or HLA-DQ eplet mismatches, particularly when grouped into high or low eplet mismatch ranges (1). While this area of solid organ transplantation continues to develop, there is anticipation that eplet mismatch analysis will eventually play a role in organ allocation.