Table 2.

Key points addressed by the American Society for Histocompatibility and Immunogenetics expert panel during the Banff 2015 conference for improving the current diagnostic system

Key points
Comprehensive typing of recipient and donor is required to determine presence of HLA‐DSA (HLA‐A, ‐B, ‐C, ‐DRB1, ‐DRB3/4/5, ‐DQA1, ‐DQB1, ‐DPA1, ‐DPB1).
Determine DSA specificity at the allelic level (including DQA and DQB and for other loci when allelic‐specific antibodies are present).
Recognize the assay limitations and minimize the inherent issues with reagents and patient sera when DSA specificity and level are considered: Inhibition in the presence of intrinsic or extrinsic factors Oversaturation of single antigen beads Denatured or cryptic epitopes that are not clinically relevant Identification of all donor HLA antigens in the assay platform used to demonstrate the presence of DSA
Correlation of DSA with biopsy findings including molecular data should incorporate some quantitation of antibody level to better estimate DSA burden.

DSA, donor‐specific antibody.