{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T03:57:34Z","timestamp":1785470254773,"version":"3.56.0"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HLA"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Given the risk of antibody\u2010mediated rejection, most kidney graft allocation systems define unacceptable antigens to prevent transplantation in the presence of donor\u2010specific antibodies. Anti\u2010HLA\u2010C and anti\u2010HLA\u2010DP antibodies are often not included in these algorithms, including the French allocation system, despite growing evidence supporting their pathogenicity. In routine clinical practice, however, these antibodies are frequently considered by transplant teams when evaluating donor offers, creating a discrepancy between allocation scores and real\u2010world access to transplantation. We aimed to evaluate the impact of this discrepancy on access to kidney transplantation. We conducted a retrospective study including 2160 patients registered on the kidney transplant waiting list at our centre between 2009 and 2018, in whom anti\u2010HLA\u2010C and anti\u2010HLA\u2010DP antibodies were systematically considered in clinical decision\u2010making similarly to other HLA antibodies. Anti\u2010HLA\u2010C\/DP antibodies were detected in 325 patients (15.1%). Incorporating these antibodies into cPRA calculations resulted in a near\u2010systematic increase in cPRA values (mean increase, 5.5\u2009\u00b1\u200911.3). Using relative loss of graft access (RLGA), 83.5% of patients experienced reduced estimated access to transplantation, including 21.5% who lost more than 75% of their access. Patients harbouring anti\u2010HLA\u2010C\/DP antibodies also exhibited significantly reduced access to kidney transplantation in both univariable and multivariable analyses (HR\u2009=\u20090.52; 95% CI, 0.42\u20130.66;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20092\u2009\u00d7\u200910\n                    <jats:sup>\u22128<\/jats:sup>\n                    ), associated with higher immunological donor offer refusal rates (mean 25.7% vs. 1.8%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20092\u2009\u00d7\u200910\n                    <jats:sup>\u221216<\/jats:sup>\n                    ). In conclusion, excluding anti\u2010HLA\u2010C and anti\u2010HLA\u2010DP antibodies from allocation algorithms, despite their consideration in routine clinical decision\u2010making, is associated with reduced access to kidney transplantation, and their integration could improve equity among transplant candidates.\n                  <\/jats:p>","DOI":"10.1111\/tan.70822","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T12:36:45Z","timestamp":1783427805000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Excluding Anti\u2010\n                    <scp>HLA<\/scp>\n                    \u2010C and \u2010\n                    <scp>DP<\/scp>\n                    Antibodies From the Allocation System on Kidney Transplant Access"],"prefix":"10.1111","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2050-6572","authenticated-orcid":false,"given":"Margot","family":"Lepage","sequence":"first","affiliation":[{"name":"National Blood Service (EFS), HLA Laboratory  D\u00e9cines\u2010Charpieu France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1281-0433","authenticated-orcid":false,"given":"Thomas","family":"Barba","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Edouard Herriot Hospital, Hospices Civils de Lyon  Lyon France"},{"name":"CIRI, INSERM U1111, Universit\u00e9 Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Sup\u00e9rieure de Lyon, Univ. Lyon  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Charmetant","sequence":"additional","affiliation":[{"name":"CIRI, INSERM U1111, Universit\u00e9 Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Sup\u00e9rieure de Lyon, Univ. Lyon  Lyon France"},{"name":"Department of Transplantation, Nephrology and Clinical Immunology Edouard Herriot Hospital, Hospices Civils de Lyon  Lyon France"},{"name":"Lyon\u2010Est Medical Faculty Claude Bernard University (Lyon 1)  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc","family":"Chauvelot","sequence":"additional","affiliation":[{"name":"Department of Transplantation, Nephrology and Clinical Immunology Edouard Herriot Hospital, Hospices Civils de Lyon  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manon","family":"Guezennec","sequence":"additional","affiliation":[{"name":"Department of Transplantation, Nephrology and Clinical Immunology Edouard Herriot Hospital, Hospices Civils de Lyon  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Goret\u2010Roycourt","sequence":"additional","affiliation":[{"name":"Department of Transplantation, Nephrology and Clinical Immunology Edouard Herriot Hospital, Hospices Civils de Lyon  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0404-6746","authenticated-orcid":false,"given":"Fanny","family":"Buron","sequence":"additional","affiliation":[{"name":"Department of Transplantation, Nephrology and Clinical Immunology Edouard Herriot Hospital, Hospices Civils de Lyon  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3648-8963","authenticated-orcid":false,"given":"Olivier","family":"Thaunat","sequence":"additional","affiliation":[{"name":"CIRI, INSERM U1111, Universit\u00e9 Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Sup\u00e9rieure de Lyon, Univ. Lyon  Lyon France"},{"name":"Department of Transplantation, Nephrology and Clinical Immunology Edouard Herriot Hospital, Hospices Civils de Lyon  Lyon France"},{"name":"Lyon\u2010Est Medical Faculty Claude Bernard University (Lyon 1)  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Morelon","sequence":"additional","affiliation":[{"name":"CIRI, INSERM U1111, Universit\u00e9 Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Sup\u00e9rieure de Lyon, Univ. Lyon  Lyon France"},{"name":"Department of Transplantation, Nephrology and Clinical Immunology Edouard Herriot Hospital, Hospices Civils de Lyon  Lyon France"},{"name":"Lyon\u2010Est Medical Faculty Claude Bernard University (Lyon 1)  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9rie","family":"Dubois","sequence":"additional","affiliation":[{"name":"National Blood Service (EFS), HLA Laboratory  D\u00e9cines\u2010Charpieu France"},{"name":"CIRI, INSERM U1111, Universit\u00e9 Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Sup\u00e9rieure de Lyon, Univ. Lyon  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Koenig","sequence":"additional","affiliation":[{"name":"CIRI, INSERM U1111, Universit\u00e9 Claude Bernard Lyon I, CNRS UMR5308, Ecole Normale Sup\u00e9rieure de Lyon, Univ. Lyon  Lyon France"},{"name":"Department of Transplantation, Nephrology and Clinical Immunology Edouard Herriot Hospital, Hospices Civils de Lyon  Lyon France"},{"name":"Lyon\u2010Est Medical Faculty Claude Bernard University (Lyon 1)  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.17180"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/ti.2022.10511"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/tan.14106"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/tan.13852"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TP.0000040431.80510.98"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humimm.2005.07.005"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/iji.12552"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12709"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000000821"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15766"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2022.07.014"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/ti.2023.11416"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/tan.14879"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trre.2025.100919"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/iji.12641"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/tan.15675"},{"key":"e_1_2_8_18_1","unstructured":"Agence de la biom\u00e9decine Website https:\/\/rams.agence\u2010biomedecine.fr\/greffe\u2010renale\u20100."},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/ti.2023.11244"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ekir.2026.106340"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181aa8d93"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/tan.14521"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.humimm.2016.03.003"}],"container-title":["HLA"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tan.70822","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/tan.70822","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tan.70822","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T02:58:44Z","timestamp":1785466724000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tan.70822"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1111\/tan.70822"],"URL":"https:\/\/doi.org\/10.1111\/tan.70822","archive":["Portico"],"relation":{},"ISSN":["2059-2302","2059-2310"],"issn-type":[{"value":"2059-2302","type":"print"},{"value":"2059-2310","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-03-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70822"}}