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The major histocompatibility complex (MHC) class I\n                    <jats:italic>MICA<\/jats:italic>\n                    gene is a candidate histocompatibility locus. Here, we investigate its role in a French multicenter cohort of 1,356 kidney transplants.\n                    <jats:italic>MICA<\/jats:italic>\n                    mismatches were associated with decreased graft survival (hazard ratio (HR), 2.12; 95% confidence interval (CI): 1.45\u20133.11;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001). Both before and after transplantation anti-MICA donor-specific antibodies (DSA) were strongly associated with increased antibody-mediated rejection (ABMR) (HR, 3.79; 95% CI: 1.94\u20137.39;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001; HR, 9.92; 95% CI: 7.43\u201313.20;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001, respectively). This effect was synergetic with that of anti-HLA DSA before and after transplantation (HR, 25.68; 95% CI: 3.31\u2013199.41;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.002; HR, 82.67; 95% CI: 33.67\u2013202.97;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001, respectively). De novo-developed anti-MICA DSA were the most harmful because they were also associated with reduced graft survival (HR, 1.29; 95% CI: 1.05\u20131.58;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.014). Finally, the damaging effect of anti-MICA DSA on graft survival was confirmed in an independent cohort of 168 patients with ABMR (HR, 1.71; 95% CI: 1.02\u20132.86;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.041). In conclusion, assessment of\n                    <jats:italic>MICA<\/jats:italic>\n                    matching and immunization for the identification of patients at high risk for transplant rejection and loss is warranted.\n                  <\/jats:p>","DOI":"10.1038\/s41591-022-01725-2","type":"journal-article","created":{"date-parts":[[2022,3,14]],"date-time":"2022-03-14T13:12:40Z","timestamp":1647263560000},"page":"989-998","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["The MHC class I MICA gene is a histocompatibility antigen in kidney 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Modeling Survival Data: Extending the Cox Model (Springer, 2000).","DOI":"10.1007\/978-1-4757-3294-8"}],"container-title":["Nature Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41591-022-01725-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41591-022-01725-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41591-022-01725-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T15:31:23Z","timestamp":1652887883000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41591-022-01725-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,14]]},"references-count":30,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,5]]}},"alternative-id":["1725"],"URL":"https:\/\/doi.org\/10.1038\/s41591-022-01725-2","relation":{},"ISSN":["1078-8956","1546-170X"],"issn-type":[{"value":"1078-8956","type":"print"},{"value":"1546-170X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,14]]},"assertion":[{"value":"14 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 January 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 March 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"D.A. has a patent \u2018In vitro method for determining the likelihood of occurrence of an acute microvascular rejection (AMVR) against a renal allograft in an individual\u2019 (EP19305037.4) issued. S.B. reports grants and personal fees from BIOMICA and personal fees from GenDx. S.C. reports non-financial support from Sanofi and Astellas, and non-financial support from Novartis, outside the submitted work. N.K. reports personal fees from Abbvie, Amgen, Astellas, Biotest, CSL Behring, Chiesi, Gilead, Fresenius Medical care, Merck Sharp and Dohme, Neovii, Novartis Pharma, Sanofi, Sandoz and Shire, outside the submitted work. P.P. reports personal fees from Chiesi, outside the submitted work. All other authors have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}