• donor specific antibodies
• epitope
• eplet
• HLA
• HLA matchmaker
• kidney transplantation
• KTA
• LDKT

Human leukocyte antigen matching (AgMM)is routinely performed in kidney transplantation in order to select the best donor-recipient couple.Nowadays the development of Donor specific antibodies (DSA) is still an issue because it can determine graft rejection. The purpose of this study is to determine whether eplets HLAmismatch (EpMM) may be used in allocation algorithms to reduce the rejection probability. In a cohort of 54 LDKT patients and 84 KTA patients, all of which were serological analysis pre-transplant negative, we analyzedAgMMand, using software Matchmaker,EpMM. Patients of both groups were stratified into 2 subgroups: “Neg” (LDKT 64%, KTA 50%), e “dnDSA” (LDKT: 36% of which the 45% were positive for the Class I and 55% for the Class II; KTA 50% of which 48% positive for the Class I and 52% positive for the Class II). The “Neg” subgroup consisting of patient pre and post-TX negativesto the serologicalanalysis for the research of Ab anti-HLA. The subgroup “dnDSA” consisting of patientsthat showed a reactivity towards post-TXHLA graft antigens. Population analysis of both LDKT and KTA patients, in particular comparing the "Neg" vs "dnDSA" subgroups, showeda statistically significant increase in the load of "eplets" and antigens, both Class I and Class II, in the subgroup who developed "dnDSA": (p <0.05). EpMMwith algorithm Matchmaker would not seem to add particular advantages in predicting the formation of de-novo DSA compared to the classic AgMM approach.