World journal of transplantation · 2026
Preformed vs de novo anti-human leukocyte antigens-DQ antibodies in kidney transplantation: A retrospective study.
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Guissouss Oumaima, Achiaou Khalid, El Turk Joumana, Mourachid Asmaa, Cheggali Abdelhadi, Medkouri Ghislaine, Ramdani Benyounes, Benghanem Gharbi Mohammed, Taoudi Benchekroun Majda, Bennani Siham
Аннотация
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.
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.