HLA ‐DR/DQ Molecular Mismatch: A prognostic biomarker for primary alloimmunity

This study evaluated 664 renal transplant recipients and correlated HLA ‐DR/DQ single molecule eplet mismatch with serologic, histologic, and clinical outcomes. Compared to traditional HLA‐DR/DQ whole antigen mismatch HLA‐DR/DQ single molecule eplet mismatch improved the correlation with de novo donor‐specific antibody (dnDSA) development (AUC 0.54 versus 0.84) and allowed recipients to be stratified into low, intermediate, and high alloimmune risk categories. These risk categories were significantly correlated with primary alloimmune events including Banff ≥1A T‐cell mediated rejection (p=0.0006), HLA‐DR/DQ dnDSA development (p<0.0001), antibody ‐mediated rejection (p<0.0001), as well as all cause graft loss (p=0.0012) and each of these correlations persisted in multivariate models. Thus, HLA ‐DR/DQ single molecule eplet mismatch may represent a precise, reproducible, and widely available prognostic biomarker that can be applied to tailor immunosuppression or design clinical trials based on individual patient risk.This article is protected by copyright. All rights reserved.
Source: American Journal of Transplantation - Category: Transplant Surgery Authors: Tags: Original Article Source Type: research