The shift from serologic human leukocyte antigen (HLA) testing to allele-specific molecular testing was a necessary prerequisite to successful unrelated donor transplantation. However, although there is a correlation between allelic mismatch, graft-versus-host disease (GVHD), and mortality, post-transplant patient outcomes remain somewhat unpredictable. In this week's issue of Blood, Pidala and colleagues offer new insights into the prognostic significance of specific HLA class I mismatches and their impact on patient outcome.

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