Immunologic clustering of donor-specific antibodies and clinical outcomes in kidney transplant recipients

doi:10.5500/wjt.v16.i2.118450

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Transplant. Jun 18, 2026; 16(2): 118450
Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.118450

Immunologic clustering of donor-specific antibodies and clinical outcomes in kidney transplant recipients

Salem H Al-Qurashi, Muhammad Abdul Mabood Khalil, Hinda Hassan Khideer Mahmood, Maram Majid Alsharif, Yara Faisal Alqurashi, Lama Alghamdi, Rawan A Al-Ghamdi, Zeyad Adel Alsaedi, Aileen Jean Dela Cruz, Ghaleb A Aboasamh, Nihal Mohammed Sadagah

Salem H Al-Qurashi, Muhammad Abdul Mabood Khalil, Hinda Hassan Khideer Mahmood, Aileen Jean Dela Cruz, Ghaleb A Aboasamh, Nihal Mohammed Sadagah, Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital, Jeddah 23311, Makkah al Mukarramah, Saudi Arabia

Maram Majid Alsharif, Department of Computer Science and Artificial Intelligence, Umm Al-Qura University, Makkah 21955, Makkah al Mukarramah, Saudi Arabia

Yara Faisal Alqurashi, Lama Alghamdi, Rawan A Al-Ghamdi, Zeyad Adel Alsaedi, Department of Medicine, King Fahad Armed Forces Hospital, Jeddah 23311, Makkah al Mukarramah, Saudi Arabia

Author contributions: Khalil MAM, Sadagah NM, and Al-Qurashi SH planned and designed the outline of the manuscript; Mahmood HHK, Alsharif MM, Alqurashi YF, Alghamdi L, Al-Ghamdi RA, Alsaedi ZA, Cruz AJD, and Aboasamh GA collected data, helped in data analysis, and helped in the literature search; Khalil MAM wrote the manuscript; Sadagah NM, and Al-Qurashi SH provided funding; all authors read and agreed to the final manuscript.

AI contribution statement: ChatGPT was used only to improve the readability and language clarity of the manuscript. It did not contribute to study design, data analysis, interpretation of results, writing of scientific content, or generation of images.

Institutional review board statement: This study was approved by the Research Ethics Committee of King Fahad Armed Forces Hospital, Jeddah (No. REC 890).

Informed consent statement: Informed consent was obtained from all participants or, when applicable, from their next of kin.

Conflict-of-interest statement: We declare no conflict of interest.

Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. Access to patient-level data is restricted to protect privacy and confidentiality.

Corresponding author: Muhammad Abdul Mabood Khalil, MD, FRCP, Center of Renal Diseases and Transplantation, King Fahad Armed Forces Hospital, Al Kurnaysh Br Road, Al Andalus, Jeddah 23311, Makkah al Mukarramah, Saudi Arabia. doctorkhalil1975@hotmail.com

Received: January 6, 2026
Revised: February 28, 2026
Accepted: April 1, 2026
Published online: June 18, 2026
Processing time: 148 Days and 1.3 Hours

Core Tip

Core Tip: Donor-specific antibodies (DSA) in kidney transplant recipients (KTR) are associated with variable immunologic risk, which is not always well defined by DSA class or mean fluorescence intensity alone. In this study, an unsupervised machine learning approach was used to group DSA-positive recipients based on antibody characteristics and transplant-related factors. These groups showed apparent differences in early post-transplant risk profiles. Patients with broader and stronger antibody responses were more likely to experience adverse early outcomes, whereas those with a limited antibody burden had favorable graft function. This approach may help refine risk assessment and support more individualized management of DSA-positive KTR.