What Role Does De Novo DSA Play in Kidney Transplants?
If you are considering or planning to have a kidney transplant, you probably know that a successful transplant depends on receiving a kidney that is a good “match” for you. What you may not know is the role de novo DSA plays in determining the risk of rejection of the donated kidney.
What Is DSA?
DSA stands for donor-specific antibody. These are antibodies your immune system makes in response to specific proteins on your donor’s kidney called HLA (human leukocyte antigen) proteins. Antibodies typically protect you from infection, but in the case of a kidney transplant, they can mistake the donated organ for something harmful, triggering an immune response that attacks the transplanted kidney.
Some people already have DSAs before transplant, which can make finding a compatible donor more difficult. Others may develop DSAs after transplant: these are called de novo DSAs (“de novo” is a Latin phrase that means “anew”). So, de novo DSAs didn’t exist at the time of the transplant but were created by your body as an immune system response to the new kidney.
When de novo DSAs form, your immune system recognizes the new kidney as foreign and starts attacking it. This can cause your body to reject the kidney, which may affect how well your new kidney works or cause it to fail entirely.
Why Does It Happen?
There are a few reasons de novo DSA might develop:
- Not taking immunosuppressive medications exactly as prescribed
- Infections that trigger the immune system to become more active
- Mismatch between donor and recipient, meaning their immune systems are not fully compatible
How Can You Prevent De Novo DSA from Forming?
While there is no guaranteed way to prevent de novo DSA from forming after a transplant, the risk can be significantly reduced with a low eplet mismatch transplant.
Essentially, a low eplet mismatch transplant means there are very few differences between your body and the donor’s kidney at the immune system level.
According to the National Kidney Registry’s 2025 Outcomes Report, unsensitized patients (those who have zero antibodies against other human HLAs) who received a medium or high eplet mismatch transplant were 538% more likely to develop de novo DSA formation by three years after transplant than those who received a low eplet mismatch transplant.
Out of 129 patients who received a low eplet mismatch transplant through the NKR, just one developed de novo DSA by a year after transplant, compared to 23 out of 146 medium eplet mismatches and seven out of 39 who received a high eplet mismatch transplant. [Learn more about low eplet mismatches.]
What if De Novo DSAs Form?
Your transplant team will regularly monitor your blood after your transplant, checking for signs of de novo DSA. The earlier de novo DSAs are detected, the more options are available to manage the immune response and protect the new kidney.
If DSAs are detected, your doctors may recommend:
- Adjusting your immunosuppressive medications
- A kidney biopsy to check for signs of rejection
- Treatments like plasmapheresis (a procedure to remove antibodies from the blood) or IVIG (immunoglobulin therapy)
While de novo DSA isn’t always preventable, you may want to explore the possibility of participating in the NKR’s Kidney for Life program to give yourself the best chance of avoiding DSA formation after your transplant.
Kidney for Life uses the latest generation of DNA sequencing technology to find the best matches between donors and patients using eplet matching. The lower the eplet mismatch between a donor and a recipient, the lower the chance that de novo DSA will form, and the more likely the transplant will last a lifetime.
For more information, visit Kidney for Life.