Work

Preformed vs de novo anti-human leukocyte antigens-DQ antibodies in kidney transplantation: A retrospective study

Year: 2026

Type: article

Abstract: BACKGROUND Donor-specific antibodies (DSAs) against human leukocyte antigen (HLA)-DQ are increasingly recognized as major contributors to antibody-mediated rejection (AMR) and graft failure in kidney transplantation. However, their clinical impact remains understudied in Morocco. AIM To evaluate the presence and implications of anti-HLA-DQ DSAs in Moroccan kidney transplant recipients. METHODS We retrospectively analyzed the immunological profiles and clinical outcomes of kidney transplant recipients screened for anti-HLA antibodies between 2015 and 2020, who developed anti-HLA-DQ DSAs either before or after transplantation. Anti-HLA antibodies were identified using Luminex® single antigen bead technology, and clinical follow-up included graft function assessment, biopsy interpretation, and evaluation of immunosuppression. RESULTS In the pre-transplant group (n = 6 with confirmed donor typing), patients with low to moderate median fluorescence intensity (MFI) anti-HLA-DQ DSAs (MFI 561-1581) underwent successful transplantation and maintained stable graft function under optimized immunosuppression. In contrast, in the post-transplant group (n = 6 with confirmed donor typing), the emergence of de novo anti-HLA-DQ DSAs was consistently associated with AMR, with MFI values reaching up to 19473, with biopsy-proven AMR in 5 of 6 cases and suspicion of AMR in 1 case. Two representative cases are detailed to illustrate the clinical impact of DQ DSAs: one patient developed high-level anti-DQB1*02 de novo DSA (MFI 12029) with persistent AMR after 5 years, while another developed anti-DQA1*05: 01 de novo DSA after an early AMR episode but maintained stable graft function after 5 years (creatinine 1.48 mg/dL). CONCLUSION Our findings underscore the clinical significance of anti-HLA-DQ DSAs in Moroccan kidney transplant recipients. While preformed DSAs with low immunogenicity may permit successful transplantation, de novo DSAs strongly correlate with AMR. Proactive monitoring, including routine DSA screening and HLA-DQ typing, could improve graft outcomes by enabling early intervention and better donor selection.

Source: World Journal of Transplantation

DOI: 10.5500/wjt.v16.i1.114044