{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T09:40:35Z","timestamp":1792662035709,"version":"4.5.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003243","name":"Ministry of Health of the Czech Republic","doi-asserted-by":"publisher","award":["NW26-06-00299"],"award-info":[{"award-number":["NW26-06-00299"]}],"id":[{"id":"10.13039\/501100003243","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003243","name":"Ministry of Health of the Czech Republic","doi-asserted-by":"publisher","award":["MZO 00023001"],"award-info":[{"award-number":["MZO 00023001"]}],"id":[{"id":"10.13039\/501100003243","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Human leukocyte antigen (HLA) delisting has recently emerged as a new strategy to expand transplant opportunities in the population of broadly sensitized patients who have poor chance to receive a transplant offer through allocation systems due to present donor-specific anti-HLA antibodies [donor-specific antibody (DSA)]. Delisting involves removing selected HLAs from the unacceptable antigen list when are considered less immunogenic and\/or the corresponding antibodies are considered lower risk, thereby increasing access to transplant offers. Current approaches recommend a stepwise strategy, initially targeting lower-risk antibodies and progressively considering higher-risk incompatibilities when transplantation is otherwise unlikely. However, transplantation in the presence of pre-existing DSA remains associated with increased risk of antibody-mediated rejection and inferior graft outcomes, requiring careful patient selection, multidisciplinary management, and close post-transplant monitoring. As definitions, eligibility criteria, and implementation of delisting strategies differ substantially among centres and countries, nephrologists working within multidisciplinary teams must interpret complex immunological information and participate in organ offer decisions for highly sensitized patients. The absence of standardized definitions and uniform immunological thresholds further complicates decision-making and highlights the need for practical guidance in balancing timely transplantation against long-term graft outcomes. This review provides practical tools for understanding delisting strategies and clinical decision-making by summarizing current guidelines, clinical outcomes, and desensitization protocols to support evidence-based transplantation decisions.<\/jats:p>","DOI":"10.1093\/ndt\/gfag229","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:32:09Z","timestamp":1791286329000},"source":"Crossref","is-referenced-by-count":0,"title":["Delisting strategies in highly sensitized kidney transplant candidates"],"prefix":"10.1093","author":[{"given":"Marta","family":"D\u2019Angelo","sequence":"first","affiliation":[{"name":"Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine , Prague ,","place":["Czech Republic"]},{"name":"Nephrology Unit, Department of Medicine and Surgery, University of Parma-Parma University Hospital, Azienda Ospedaliera-Universitaria Parma , Parma ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Zahradka","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine , Prague ,","place":["Czech Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Jaklova","sequence":"additional","affiliation":[{"name":"Immunogenetics Laboratory, Transplant Center, Institute for Clinical and Experimental Medicine , Prague ,","place":["Czech Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7468-9600","authenticated-orcid":false,"given":"Umberto","family":"Maggiore","sequence":"additional","affiliation":[{"name":"Nephrology Unit, Department of Medicine and Surgery, University of Parma-Parma University Hospital, Azienda Ospedaliera-Universitaria Parma , Parma ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ondrej","family":"Viklicky","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Transplant Center, Institute for Clinical and Experimental Medicine , Prague ,","place":["Czech Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"2026102205030297200_bib1","doi-asserted-by":"publisher","first-page":"2579","DOI":"10.1056\/NEJMc1813976","article-title":"Antibody-mediated rejection of solid-organ allografts","volume":"379","author":"Lefaucheur","year":"2018","journal-title":"N Engl J Med"},{"key":"2026102205030297200_bib2","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1097\/TP.0000000000004824","article-title":"Improving the access of highly sensitized patients to kidney transplantation from deceased donors: the Spanish PATHI program with allocation based on the virtual crossmatch","volume":"108","author":"Valentin","year":"2024","journal-title":"Transplantation"},{"key":"2026102205030297200_bib3","doi-asserted-by":"publisher","first-page":"e15572","DOI":"10.1111\/tan.15572","article-title":"A personalised delisting strategy enables successful kidney transplantation in highly sensitised patients with preformed donor-specific anti HLA antibodies","volume":"103","author":"Garc\u00eda-Jim\u00e9nez","year":"2024","journal-title":"HLA"},{"key":"2026102205030297200_bib4","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1016\/j.kint.2025.04.031","article-title":"A multicenter prospective cohort study evaluating impact of an active delisting strategy to enable kidney transplantation in wait-listed candidates with calculated Panel Reactive Antibody \u2265 99.9%","volume":"108","author":"Cucchiari","year":"2025","journal-title":"Kidney Int"},{"key":"2026102205030297200_bib5","doi-asserted-by":"publisher","first-page":"540","DOI":"10.3389\/fimmu.2017.00540","article-title":"Assessment of Spanish panel reactive antibody calculator and potential usefulness","volume":"8","author":"Asensio","year":"2017","journal-title":"Front Immunol"},{"key":"2026102205030297200_bib6","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/j.kint.2017.07.018","article-title":"Kidney allocation based on proven acceptable antigens results in superior graft survival in highly sensitized patients","volume":"93","author":"Heidt","year":"2018","journal-title":"Kidney Int"},{"key":"2026102205030297200_bib7","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/iji.12558","article-title":"BSHI\/BTS guidance on crossmatching before deceased donor kidney transplantation","volume":"49","author":"Peacock","year":"2022","journal-title":"Int J Immunogenet"},{"key":"2026102205030297200_bib8","doi-asserted-by":"publisher","first-page":"110806","DOI":"10.1016\/j.humimm.2024.110806","article-title":"Low-risk delisting strategy in highly sensitized patients without donor offers included in exchange donation programs. 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