title: Posttransplant monitoring of de novo human leukocyte antigen donor-specific antibodies in kidney transplantation.
abstract: OBJECTIVE
  To summarize the evidence supporting the negative impact of de novo donor-specific antibodies (dnDSA) in renal transplantation and to describe the natural history associated with the development of dnDSA.
  
  
  RESULTS
  Recent studies have increased our appreciation of the risk factors that predispose to dnDSA while illuminating how these risk factors may relate to the pathophysiology underlying its development. In addition, details regarding the natural history of dnDSA are now available in the context of the different clinical pathologic phenotypes that occur in the patients in whom it develops. Common pitfalls in defining and monitoring dnDSA, when understood, may provide some explanation for the heterogeneity in published studies.
  
  
  CONCLUSIONS
  Recognizing that dnDSA is a major cause of late graft loss, and, more importantly, is detectable in many cases long before dysfunction or graft loss occurs, identifies an opportunity to intervene and change the outcome for the patient.
authors.affiliation: Department of Medicine and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Wiebe
authors.forename: Peter
authors.initials: P
authors.lastname: Nickerson
mesh_terms: D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000276:immunology*; D015166:Monitoring, Immunologic / Q000379:methods*; D012307:Risk Factors; D014019:Tissue Donors; D023001:Transplantation Tolerance
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies