ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-OR079

HLA-DQ Mismatching and Kidney Transplant Outcomes: A UNOS/OPTN Analysis

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Leeaphorn, Napat, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, United States
  • Pena, J. ryan, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, United States
  • Thamcharoen, Natanong, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, United States
  • Khankin, Eliyahu V., Beth Israel Deaconess Medical Center, Brookline, Massachusetts, United States
  • Pavlakis, Martha, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, United States
  • Cardarelli, Francesca, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, United States
Background

Recent evidence suggests that HLA epitope-mismatching at HLA-DQ loci is strongly associated with the development of anti-DQ donor-specific antibodies (DSA) and adverse graft outcomes. However, the clinical significance of broad antigen HLA-DQ mismatching (MM) in predicting graft outcomes is not well examined. Using UNOS/OPTN data, we analyzed the effect of HLA-DQ MM on graft outcomes.

Methods

Patients with primary kidney transplants performed between 2007 and 2015 were included. Patients were classified as having either zero HLA-DQ MM, one or two HLA-DQ MM. Primary outcomes were death-censored graft survival (DCGS), and incidence of acute rejection.

Results

95,664 patients were included in the analysis, with median follow-up time of 3.45 years. Of these, 22,379 (23.39%) and 73,294 (76.61%) received zero and one or two HLA-DQ MM kidneys, respectively. After adjusting for HLA-ABDR, various recipient and donor variables and initial immunosuppression, HLA-DQ MM was associated with an increased risk of graft loss in living donor kidney transplant (LDKT) recipients with an adjusted hazard ratio (HR) of 1.12 (95% CI, 1.01-1.26; p=0.042), but not in deceased donor kidney transplant (DDKT) recipients (HR 1.07, 95% CI, 0.99-1.53; p=0.066). When taking cold ischemic time (CIT) into account, HLA-DQ MM was an independent factor for an increased risk of graft loss in DDKT recipients with CIT ≤ 17 hours (HR 1.15, 95% CI 1.03-1.27; p=0.010), but not in DDKT recipients with CIT > 17 hours (HR 1.00, 95% CI, 0.90-1.11; p=0.971). Compared with recipients who received zero HLA-DQ MM kidneys, those who received one or two HLA-DQ MM kidneys had a higher incidence of acute rejection at 1-year with adjusted odd ratios of 1.12 (95% CI, 1.02-1.22; p=0.012) in DDKT and 1.14 (95% CI, 1.03-1.28; p=0.016) in LDKT, respectively.

Conclusion

HLA-DQ mismatching is a predictor for graft survival and acute rejection independent of mismatching of HLA-ABDR and initial immunosuppression. Cold ischemic times of longer than 17 hours appear to obviate the benefit of zero HLA-DQ MM.