{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:42:10Z","timestamp":1786117330733,"version":"build-2736575974"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Highly sensitized kidney transplant candidates face major barriers to transplantation because broad anti-HLA antibody reactivity substantially limits donor compatibility. We conducted a retrospective cohort study comparing two allocation eras in Pernambuco, Brazil: a pre-EpViX era (2005\u20132014; n=3,136) and an EpViX era (2016\u20132025; n=4,544). We evaluated the association between an epitope-informed definition of unacceptable antigens integrated with virtual crossmatching and access to deceased-donor kidney transplantation. The proportion of candidates who underwent transplantation was higher during the EpViX era (50%) than during the pre-EpViX era (36%) (p&amp;lt;0.001), while median waiting time among transplanted recipients decreased from 22 to 7 months (p&amp;lt;0.001). Among highly sensitized candidates (cPRA \u226580%), the estimated probability of transplantation at 12 months was 17% in the EpViX era compared with 3% in the pre-EpViX era. In adjusted analyses, listing during the EpViX era was associated with a higher likelihood of transplantation (HR 2.55; 95% CI 2.37\u20132.74; p&amp;lt;0.001). Epitope-level virtual crossmatch demonstrated high concordance with prospective complement-dependent cytotoxicity crossmatch, with sensitivity of 98.7%, specificity of 93.4%, and a negative predictive value of 99.6%. An allocation strategy incorporating an epitope-informed definition of unacceptable antigens was associated with greater access to deceased-donor kidney transplantation, including among highly sensitized candidates, while maintaining high concordance with prospective crossmatch testing.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1879817","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:26:35Z","timestamp":1785212795000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Retrospective cohort study of epitope-based virtual crossmatch allocation in a public transplant system (Pernambuco, Brazil)"],"prefix":"10.3389","volume":"17","author":[{"given":"Rafael Melo Santos de Serpa","family":"Brand\u00e3o","sequence":"first","affiliation":[{"name":"Laborat\u00f3rio de Imunogen\u00e9tica e Biologia Molecular (LIB-UFPI), Universidade Federal do Piau\u00ed","place":["Teresina, 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