Korean J Transplant.  2022 Nov;36(Supple 1):S98. 10.4285/ATW2022.F-2192.

Evaluating the effect of Anti-HLA-DR51/52/53 donor-specific antibodies on antibody-mediated rejection in kidney transplantation recipients

• Kim J
• Shin KH
• Song SH
• Kim HH

• KMID: 2535614
• DOI: http://doi.org/10.4285/ATW2022.F-2192

Abstract

Background
The donor-specific antibody (DSA) is a well-known biomarker for predicting antibody-mediated rejection in allograft transplantation. The antigenicity of anti-HLA-DR51/52/53 antigens is relatively weaker than those of HLA-A, -B, and -DR, and its clinical significance is yet understudied. We conducted this study to seek the clinical relevance of anti-HLA-DR51/52/53 DSAs in kidney transplant recipients by evaluating allograft rejections.
Methods
All patients who received kidney transplantation between January 2011 and August 2022 were investigated retrospectively using electro-medical records. The single-antigen-bead panel reactive antibody (PRA) results and the history of graft rejection were analyzed. Since our institution did not perform HLA-DRB3/DRB4/DRB5 typing, whether the patients anti-HLADR51/52/53 antibody can be considered a DSA, defined as possible anti-HLA-DR51/52/53 DSA, was assumed using the linkage disequilibrium based on the donors HLA-DRB1 type.
Results
Among 305 patients who underwent kidney transplantation, 56 (18.36%) presented anti-HLA-DR51/52/53 antibodies in single PRA tests during a median follow-up of 758.50 days (range, 1–3879 days). Thirty-four patients harbored possible antiHLA-DR51/52/53 DSAs, and 22 showed non-DSA anti-HLA-DR51/52/53 antibodies. Table 1 represents the characteristics of two groups, including anti-HLA-DR51/52/53 type, preformed/de novo, and presence of other PRAs and DSA. The antibody-mediated rejection occurred more frequently in the possible anti-HLA-DR51/52/53 DSA group. However, they were not statistically signif-icant in both univariate and multivariate analysis (Cox proportional hazard model: hazard ratio, 2.110; 95% confidence interval, 0.556–8.006; P=0.273).
Conclusions
Although the antibody-mediated rejection was higher in the possible anti-HLA-DR51/52/53 DSA group compared to the non-DSA anti-HLA-DR51/52/53 group, no statistically significant difference was observed. Further studies should include more detailed information such as the type of other DSAs and PRAs, grade of ABMR, mean fluorescence intensities, and donors HLA-DRB3/4/5 type to elucidate the clinical relevance of anti-HLA-DR51/52/53 antibodies.