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However, no uniform monitoring strategy has been validated in pediatric recipients. This educational review recommends that post-transplant HLA antibody monitoring in children should be tailored to the individual patient\u2019s immunological risk profile rather than applied as a fixed schedule. Pediatric recipients face a heterogeneous risk landscape due to prolonged allograft exposure, high age-specific risk of nonadherence during adolescence, and the influence of the chosen immunosuppressive regimen, which demands a differentiated approach. Drawing on current international consensus documents, multicenter registry data, and emerging pediatric cohort studies, this review examines the scientific basis of HLA antibody-mediated injury, the available diagnostic tools, and the supporting evidence for risk-adapted monitoring intervals, individualized trigger-based testing, and interpretation of test results as mean fluorescence intensity (MFI) in a clinical context. We give special attention to adolescence and nonadherence as high-risk categories warranting intensified surveillance. We aim to provide a practical framework for tailored personalized HLA antibody monitoring that is applicable in the daily care of pediatric kidney transplant recipients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00467-026-07497-y","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T10:21:07Z","timestamp":1787566867000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tailoring HLA antibody monitoring post-transplantation"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9939-4059","authenticated-orcid":false,"given":"Alexander","family":"Fichtner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8587-5989","authenticated-orcid":false,"given":"Thuong Hien","family":"Tran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6598-6910","authenticated-orcid":false,"given":"Burkhard","family":"T\u00f6nshoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"7497_CR1","doi-asserted-by":"publisher","first-page":"2600","DOI":"10.1111\/j.1600-6143.2008.02410.x","volume":"8","author":"DL Gillen","year":"2008","unstructured":"Gillen DL, Stehman-Breen CO, Smith JM, McDonald RA, Warady BA, Brandt JR, Wong CS (2008) Survival advantage of pediatric recipients of a first kidney transplant among children awaiting kidney transplantation. 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