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In accordance with our study, Yazawa et al. described that the presence of pre-transplant DSA in SLKT is not associated with worse outcomes in the patients or the kidney graft (1, 2). However, the persistence or de novo class II DSA development after SLKT has been associated with worse outcomes (3-5). It has been proposed that class II DSAs may not be absorbed by the liver, but this is not the only immunomodulatory mechanism driven by the liver (6, 7). This article is protected by copyright. All rights reserved.Arbuscular mycorrhiza