Publication Name	World Journal of Transplantation
Manuscript ID	122485
Country	Saudi Arabia

Category	Transplantation
Manuscript Type	Retrospective Study
Article Title	Impact of pretransplant donor-specific antibodies and human leukocyte antigen mismatches on graft and patient outcomes: A cohort from Saudi Arabia
Manuscript Source	Unsolicited Manuscript
All Author List	Salem H Al-Qurashi, Muhammad Abdul Mabood Khalil, Hinda Hassan Khideer Mahmood, Alfatih Abdalla Altom, Yara Faisal Alqurashi, Zeyad Adel Alsaedi, Aileen Jean Dela Cruz, Maram Majid Alsharif, Rayan Mohammed Bawayan, Abdulrahman A Housawi and Nihal Mohammed Sadagah
Funding Agency and Grant Number
Corresponding Author	Muhammad Abdul Mabood Khalil, FRCP, Renal Diseases and Transplantation Centre, King Fahad Armed Forces Hospital, Jeddah, Al Kurnaysh Br Rd, Al Andalus, Jeddah 23311, Makkah al Mukarramah, Saudi Arabia. doctorkhalil1975@hotmail.com
Key Words	Kidney transplantation; Donor-specific antibodies; Human leukocyte antigen mismatch; Acute rejection; Graft function; Middle East
Core Tip	In this large single-center study from the Middle East, pretransplant donor-specific antibodies (DSA) were frequently observed but were not independently associated with rejection or survival after accounting for other factors. Instead, a higher human leukocyte antigen mismatch burden (≥ 7) and poorer early graft function were more closely associated with adverse outcomes. These findings suggest that with current induction strategies, particularly the widespread use of antithymocyte globulin (ATG), the effect of preformed DSA may be less pronounced than traditionally expected. In everyday practice, this highlights the importance of looking beyond antibody status alone and paying closer attention to donor-recipient matching and early graft performance when assessing risk after transplantation. However, the high use of ATG and the relatively short follow-up may have attenuated or delayed the detectable impact of DSA on graft outcomes, particularly late rejection or chronic antibody-mediated injury.
Citation	Al-Qurashi SH, Khalil MAM, Mahmood HHK, Altom AA, Alqurashi YF, Alsaedi ZA, Dela Cruz AJ, Alsharif MM, Bawayan RM, Housawi AA, Sadagah NM. Impact of pretransplant donor-specific antibodies and human leukocyte antigen mismatches on graft and patient outcomes: A cohort from Saudi Arabia. World J Transplant 2026; In press

Received	2026-04-27 03:10
Peer-Review Started	2026-04-27 03:13
First Decision by Editorial Office Director	2026-06-08 07:32
Return for Revision	2026-06-08 07:32
Revised	2026-06-27 20:26
Publication Fee Transferred	2026-07-06 13:57
Second Decision by Editor	2026-07-13 02:36
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-07-13 03:29
Articles in Press	2026-07-13 03:29
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	2220-3230 (online)
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