High Antibody Levels Delay Blood, Marrow Transplants

Johns Hopkins study finds minority patients face longer waits for compatible donors due to elevated anti-HLA antibodies.

Apr. 15, 2026 at 12:28am

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A highly detailed, translucent X-ray image of the internal structure of human bone marrow, conceptually representing the complex medical challenges faced by transplant patients with high antibody levels.Elevated antibody levels in minority transplant patients create significant barriers to finding compatible donors, delaying life-saving procedures.Baltimore Today

A recent study from the Johns Hopkins Kimmel Cancer Center found that people with elevated levels of donor-specific anti-HLA antibodies (DSAs) - immune system proteins that can attack donor stem cells - wait an average of 3 additional months to receive blood or bone marrow transplants from healthy donors. The issue disproportionately affects Black women who have had prior pregnancies, with minority patients overall less likely to receive transplants from unrelated donors.

Why it matters

Elevated DSA levels can lead to graft failure and other negative outcomes for transplant patients. This research highlights disparities in the transplant process, with minority patients facing longer waits and more difficulty finding compatible donors due to their antibody profiles.

The details

The study reviewed records from 2014-2022 of 408 transplant patients who had at least one antibody against a potential donor. Patients with high DSA levels required an average of 4 potential donors to be evaluated, compared to 2 for those without high antibodies. The median time to transplant was 120 days for those with elevated DSAs, versus 90 days for those without. Minorities overall were less likely to receive transplants from unrelated donors and more likely to get suboptimal related donor matches.

  • The study was published online on November 7, 2025.
  • The research reviewed patient records from 2014 to 2022.

The players

Christian Gocke

An assistant professor of oncology at the Johns Hopkins University School of Medicine and the lead author of the study.

Maria Bettinotti

The senior study author and director of the Immunogenetics Laboratory at Johns Hopkins, who provided key DSA laboratory data for the analysis.

Johns Hopkins Kimmel Cancer Center

The institution where the research was conducted.

National Institutes of Health

The organization that provided funding support for the study.

National Cancer Institute

The NIH institute that provided grant funding for the work through grant P01 CA2259.

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What they’re saying

“DSAs are really one of the key determinants in whether the donor search goes smoothly. They can sometimes change over time and shoot up at the last minute, making the process of finding a compatible donor more complicated.”

— Christian Gocke, Assistant Professor of Oncology, Johns Hopkins University School of Medicine

“About half of patients can be helped through a desensitization protocol developed at Johns Hopkins that increases the odds of a patient being able to successfully accept a transplant from a donor.”

— Christian Gocke, Assistant Professor of Oncology, Johns Hopkins University School of Medicine

What’s next

Gocke is now the principal investigator of a new clinical trial testing the drug Darzalex Faspro, typically used for multiple myeloma, to kill antibody-making cells before the desensitization protocol.

The takeaway

This research highlights significant disparities in the transplant process, with minority patients facing longer waits and more difficulty finding compatible donors due to elevated antibody levels. Developing more effective desensitization protocols is critical to improving access and outcomes for these vulnerable populations.