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The detection of anti-HLA DSA is widely used for the assessment of pre- and posttransplant risks of rejection and allograft loss; however, not all anti-HLA DSA carry the same risk for transplant outcomes. These antibodies have been shown to cause a wide spectrum of effects on allografts, ranging from the absence of injury to indolent or full-blown acute antibody-mediated rejection. Consequently, the presence of circulating anti-HLA DSA does not provide a sufficient level of accuracy for the risk stratification of allograft outcomes. Enhancing the predictive performance of anti-HLA DSA is currently one of the most pressing unmet needs for facilitating individualized treatment choices that may improve outcomes. Recent advancements in the assessment of anti-HLA DSA properties, including their strength, complement-binding capacity, and IgG subclass composition, significantly improved the risk stratification model to predict allograft injury and failure. Although risk stratification based on anti-HLA DSA properties appears promising, further specific studies that address immunological risk stratification in large and unselected populations are required to define the benefits and cost-effectiveness of such comprehensive assessment prior to clinical implementation.<\/jats:p>","DOI":"10.1155\/2017\/5201098","type":"journal-article","created":{"date-parts":[[2017,1,2]],"date-time":"2017-01-02T21:00:57Z","timestamp":1483390857000},"page":"1-8","source":"Crossref","is-referenced-by-count":33,"title":["From Humoral Theory to Performant Risk Stratification in Kidney Transplantation"],"prefix":"10.1155","volume":"2017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6244-0795","authenticated-orcid":true,"given":"C.","family":"Lefaucheur","sequence":"first","affiliation":[{"name":"Paris Translational Research Center for Organ Transplantation, INSERM, UMR-S970, Paris, France"},{"name":"Kidney Transplant Department, Saint-Louis Hospital, 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