Impact of HLA evolutionary divergence and donor-recipient molecular mismatches on antibody-mediated rejection of kidney allografts.

ABSTRACT: Several in-silico methods emerge to assess HLA immunogenicity and stratify immunological risk, including HLA molecular mismatches and HLA evolutionary divergence (HED). However, their added value in risk-stratifying antibody-mediated rejection (AMR) remains uncertain. We include 5159 kidney transplant recipients from four centers. Thirty-three clinical and immunological parameters are assessed, including HLA eplet mismatches, PIRCHE-II scores, and HED. Their associations with AMR are evaluated using Cox models. AMR occurrs in 1024 patients (19.9%). Immunological determinants of AMR include anti-HLA DSA (MFI:500-1400, HR:1.87; MFI > 1400, HR:3.84, p < 0.001) and HLA Class II eplet mismatches (HR:1.02, p < 0.001). HLA-DQB1-derived (HR:1.01, p = 0.005) and HLA-DRB1-derived PIRCHE-II scores (H

SUBMITTER: Demir Z 

PROVIDER: S-EPMC12219110 | biostudies-literature | 2025 Jul

REPOSITORIES: biostudies-literature