HLA diagnostics have seen a renaissance in the last decade, which is translating into marked improvement in pre-transplant risk assessment for the clinician. Specifically, solid phase assays are being used to detect low levels of immunologic memory towards the donor in the form of donor specific antibodies. With this knowledge clinicians can decide if they want to proceed across this memory barrier with desensitization and depletional induction therapy or avoid it all together through national kidney paired donation programs (living donor program) or national sharing for highly sensitized patients (deceased donor program). Molecular HLA typing across all known HLA loci (HLA – A, B, Cw, DRB1, DRB3/4/5, DQA1/B1, DPA1/B1) is also becoming the standard of care in most programs. With this knowledge clinicians can now use computational software to determine the molecular mismatch between the donor and recipient at the epitope level. Recent work by a number of groups are demonstrating the utility of such an analysis to personalize immunosuppression protocols – we are seeing the dawn of precision medicine in transplantation.
