Sensitization in Organ Transplantation: Assessment of Risk (STAR) 2025 Meeting Group Report

Authors

Carrie A. Schinstock, Division of Nephrology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: Schinstock.carrie@mayo.edu.
Howard Gebel, Department of Surgery, Emory Transplant Center, Emory University School of Medicine, Atlanta, Georgia, USA.
Idoia Gimferrer, Immunogenetics/HLA Laboratory, Bloodworks Northwest, Seattle, Washington, USA.
Marlena Habal, Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
Sebastiaan Heidt, Erasmus MD Transplant Institute, Department of Internal Medicine, Division of Nephrology & Transplantation, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands.
Michelle J. Hickey, Department of Pathology and Laboratory Medicine, UCLA Immunogenetics Center, University of California Los Angeles, Los Angeles, CA, USA.
Annette M. Jackson, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
Vasilis Kosmoliaptsis, Department of Surgery, University of Cambridge, Cambridge, UK.
Nicole Valenzuela, MaineHealth

Document Type

Article

Publication Date

1-8-2026

Institution/Department

Nephrology & Transplantation

Journal Title

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

Abstract

The Sensitization in Transplantation: Assessment of Risk (STAR) initiative aims to translate HLA laboratory data into clinical practice and identify key knowledge gaps to guide future research. The STAR working group has held three consensus meetings and published reports that have influenced clinical care. In 2025, the group focused on five evolving areas: donor-derived cell-free DNA (dd-cfDNA) tests, innate immunity in allograft rejection, immunogenicity and antigenicity, HLA antibody quantification, and non-HLA antibodies. Three years of work culminated in two webinars and a February 2025 community meeting summarized in this report. The group outlined considerations for integrating dd-cfDNA tests into practice, proposed a definition for genetic prediction of NK-cell missing self, and discussed monocyte activation via the SIRPα-CD47 pathway. They reviewed molecular mismatch approaches, limitations, and immune-recognition complexities. Finally, they provided updates on HLA antibody quantification, non-HLA antibodies, and ongoing studies addressing critical knowledge gaps.

Recommended Citation

Schinstock, Carrie A.; Gebel, Howard; Gimferrer, Idoia; Habal, Marlena; Heidt, Sebastiaan; Hickey, Michelle J.; Jackson, Annette M.; Kosmoliaptsis, Vasilis; and Valenzuela, Nicole, "Sensitization in Organ Transplantation: Assessment of Risk (STAR) 2025 Meeting Group Report" (2026). MaineHealth Maine Medical Center. 4303.
https://knowledgeconnection.mainehealth.org/mmc/4303