ArticleWorld journal of transplantation2026
Immunologic clustering of donor-specific antibodies and clinical outcomes in kidney transplant recipients.
Article in World journal of transplantation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDonor-specific antibodies (DSA) against human leukocyte antigens (HLA) are associated with increased immunologic risk in kidney transplant recipients (KTR). However, outcomes among DSA-positive patients are highly variable. Traditional markers, such as DSA class and mean fluorescence intensity (MFI), often fail to capture the multidimensional nature of immunologic risk.
aimThis retrospective study aims to stratify DSA-positive KTR into immunologic risk groups using unsupervised machine learning and to assess the relationship between antibody profiles and early post-transplant outcomes.
methodsDuring the study period, 260 kidney transplants were performed at King Fahad Armed Forces Hospital in Saudi Arabia, of which 151 recipients were DSA-positive. Clustering analysis was performed in 112 DSA-positive recipients with complete immunologic and follow-up data. Key variables used for clustering included DSA class, number of DSA, cumulative MFI, early graft function (estimated glomerular filtration rate at 4 months), and HLA mismatch. K-means clustering was applied to identify distinct immunologic risk groups. Clinical outcomes, including acute rejection, graft loss, delayed graft function, and mortality, were compared across clusters.
resultsThree distinct clusters were identified: High-risk (
conclusionUnsupervised clustering effectively stratifies DSA-positive KTR into clinically meaningful risk groups. High-risk recipients with broad and strong DSA profiles are more likely to experience early adverse outcomes. Low-risk recipients have favorable early graft function. This data-driven approach may help guide individualized monitoring, donor selection, and immunosuppression strategies for DSA-positive KTR.
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