Advancements in antibody testing and HLA genotyping has greatly improved our understanding of the HLA compatibility between patients and donors.
However, development of donor-specific antibodies and long term allograft survival are not equally improved and the current treatment strategies seems to have reached a plateau. Conventional HLA compatibility is based on a method that does not account for the immunogenic differences between patients and donors. Molecular HLA compatibility holds the promise to provide a superior compatibility assessment. Retrospective studies have demonstrated that, by taking into account the amount of donor-derived HLA peptides, amino-acids and HLA eplets, the HLA Laboratory can provide a more accurate and patient-dependent risk assessment. By lowering the amount of immunogenic differences between patients and donors, the risk of de-novo DSA and rejection can be greatly reduced. In this presentation, the current molecular HLA compatibility assessment tools, their predictive power and clinical applications will be examined and discussed.