A Comparison of HLA Molecular Mismatch Methods to Determine HLA Immunogenicity. Issue 8 (August 2018)

• Record Type: Journal Article
• Authors: Wiebe, Chris; Kosmoliaptsis, Vasilis; Pochinco, Denish; Taylor, Craig J.; Nickerson, Peter
• Is Part Of: Transplantation. Volume 102:Issue 8(2018)
• Publication Date: 2018-08
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000002117
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: Antibody-mediated rejection is a major cause of premature graft loss in kidney transplantation. Multiple scoring systems are available to assess the HLA mismatch between donors and recipients at the molecular level; however, their correlation with the development of de novo donor-specific antibody (dnDSA) has not been compared in recipients on active immunosuppression. Methods: HLA-DRβ1/3/4/5 /DQα1β1 molecular mismatch was determined using eplet analysis, amino acid mismatch, and electrostatic mismatch for 596 renal transplant recipients and correlated with HLA-DR/DQ dnDSA development. The molecular mismatch scores were evaluated in multivariate models of posttransplant dnDSA-free survival. Results: Eplet mismatch correlated with amino acid mismatch and electrostatic mismatch ( R 2 = 0.85-0.96). HLA-DR dnDSA-free survival correlated with HLA-DR eplet mismatch (hazards ratio [HR], 2.50 per 10 eplets mismatched; P < 0.0001), amino acid mismatch (HR, 1.49 per 10 amino acids mismatched; P < 0.0001), and electrostatic mismatch (HR, 1.23 per 10 units mismatched; P < 0.0001). HLA-DQ dnDSA-free survival correlated with HLA-DQ eplet mismatch (HR, 1.98 per 10 eplets mismatched; P < 0.0001), amino acid mismatch (HR, 1.24 per 10 amino acids mismatched; P < 0.0001), and electrostatic mismatch (HR, 1.14 per 10 units mismatched; P < 0.0001). All 3 methods were significant multivariate correlates of dnDSA development after adjustment for recipient age, baseline immunosuppression, and nonadherence. Conclusions: HLA molecular mismatch represents a precise method of alloimmune risk assessment for renal transplant patients. The method used to determine the molecular mismatch is likely to be driven by familiarity and ease of use as highly correlated results are produced by each method. Abstract : In order to assess alloimmune risk in kidney transplant recipiennts, the authors compare 3 methods evaluating HLA molecular mismatch (HLA-DG eplet, amino acid and electrostatic) which all correlate with adjusted dnDSA development. Supplemental digital content is available in the text.