Impact of pretransplant donor-specific antibodies and human leukocyte antigen mismatches on graft and patient outcomes: A cohort from Saudi Arabia

doi:10.5500/wjt.122485

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 16, Issue 3

This Article

(0)

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Journal Information of This Article

Publication Name

World Journal of Transplantation

ISSN

2220-3230

Publisher of This Article

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

- Full Article (XML)

Retrospective Study

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. Sep 18, 2026; 16(3): 122485
Published online Sep 18, 2026. doi: 10.5500/wjt.122485

Impact of pretransplant donor-specific antibodies and human leukocyte antigen mismatches on graft and patient outcomes: A cohort from Saudi Arabia

Salem H Al-Qurashi, Muhammad Abdul Mabood Khalil, Hinda Hassan Khideer Mahmood, Alfatih Abdalla Altom, Yara Faisal Alqurashi, Zeyad Adel Alsaedi, Aileen Jean Dela Cruz, Maram Majid Alsharif, Rayan Mohammed Bawayan, Abdulrahman A Housawi, Nihal Mohammed Sadagah

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

Yara Faisal Alqurashi, Zeyad Adel Alsaedi, Department of Medicine, 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

Rayan Mohammed Bawayan, Department of Pathology and Clinical Medicine, HLA Lab., King Faisal Specialist Hospital & Research Center, Jeddah 2199, Makkah al Mukarramah, Saudi Arabia

Abdulrahman A Housawi, Ministry of Health, Riyad 11176, Saudi Arabia

Author contributions: Al-Qurashi SH and Khalil MAM conceptualized the review and designed its overall structure; Khalil MAM performed the literature search, critically evaluated the published evidence, and drafted the initial manuscript; Mahmood HHK, Altom AA, Alqurashi YF, Alsaedi ZA, Dela Cruz AJ, Alsharif MM, Bawayan RM, Housawi AA, and Sadagah NM contributed to the literature review, interpretation of the evidence, and critical revision of the manuscript for important intellectual content; Al-Qurashi SH supervised the study and provided overall scientific guidance; and all authors reviewed the manuscript, approved the final version, and agree to be accountable for all aspects of the work.

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. REC849).

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

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

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, FRCP, Renal Diseases and Transplantation Centre, King Fahad Armed Forces Hospital, Jeddah, Al Kurnaysh Br Road, Al Andalus, Jeddah 23311, Makkah al Mukarramah, Saudi Arabia. doctorkhalil1975@hotmail.com

Received: April 27, 2026
Revised: June 27, 2026
Accepted: July 13, 2026
Published online: September 18, 2026
Processing time: 131 Days and 16.3 Hours

Core Tip

Core Tip: In this large single-center study from the Middle East, pretransplant donor-specific antibodies (DSA) were frequently observed but were not independently associated with rejection or survival after accounting for other factors. Instead, a higher human leukocyte antigen mismatch burden (≥ 7) and poorer early graft function were more closely associated with adverse outcomes. These findings suggest that with current induction strategies, particularly the widespread use of antithymocyte globulin (ATG), the effect of preformed DSA may be less pronounced than traditionally expected. In everyday practice, this highlights the importance of looking beyond antibody status alone and paying closer attention to donor-recipient matching and early graft performance when assessing risk after transplantation. However, the high use of ATG and the relatively short follow-up may have attenuated or delayed the detectable impact of DSA on graft outcomes, particularly late rejection or chronic antibody-mediated injury.