In single-center studies, HLA-DQ mismatches stimulate the most pathogenic donor-specific antibodies. However, because of limitations of transplant registries, this cannot be directly confirmed with registry-based analyses.

We evaluated patients in the Scientific Registry of Transplant Recipients who were relisted after renal graft failure with new, unacceptable antigens corresponding to the HLA typing of their previous donor (UA-PD) as a proxy for donor-specific antibodies. Linear regression was applied to estimate the effects of HLA mismatches on UA-PD and the effects of UA-PD on calculated panel reactive antibody (cPRA) values for 4867 kidney recipients from 2010 to 2021.

Each additional HLA-DQ mismatch increased the probability of UA-PD by 25.2% among deceased donor transplant recipients and by 28.9% among living donor transplant recipients, significantly more than all other HLA loci (P<0.05). HLA-DQ UA-PD increased cPRA by 29.0% in living donor transplant recipients and by 23.5% in deceased donor transplant recipients, significantly more than all loci except for HLA-A in deceased donor transplant recipients (23.1%). African American deceased donor transplant recipients were significantly more likely than Hispanic and White recipients to develop HLA-DQ UA-PD; among living donor transplant recipients, African American or Hispanic recipients were significantly more likely to do so compared with White recipients. Models evaluating interactions between HLA-DR/DQ mismatches revealed largely independent effects of HLA-DQ mismatches on HLA-DQ UA-PD.

HLA-DQ mismatches had the strongest associations with UA-PD, an effect that was greatest in African American and Hispanic recipients. cPRA increases with HLA-DQ UA-PD were equivalent or larger than any other HLA locus. This suggests a need to consider the effects of HLA-DQ in kidney allocation.

在单中心研究中，HLA-DQ 错配会刺激最具致病性的供体特异性抗体。然而，由于移植登记的局限性，这一点无法通过基于登记的分析直接证实。

我们评估了移植受者科学登记册中的患者，这些患者在肾移植失败后重新登记，并使用与先前供体 (UA-PD) 的 HLA 分型相对应的新的、不可接受的抗原作为供体特异性抗体的代表。应用线性回归来估计 2010 年至 2021 年 4867 名肾受者的 HLA 错配对 UA-PD 的影响以及 UA-PD 对计算的面板反应性抗体 (cPRA) 值的影响。

每增加一个 HLA-DQ 错配，已故供​​体移植受者中 UA-PD 的概率就会增加 25.2%，活体供体移植受者中 UA-PD 的概率会增加 28.9%，显着高于所有其他 HLA 基因座（ P <0.05）。 HLA-DQ UA-PD 使活体移植受者的 cPRA 增加 29.0%，在已故供体移植受者中增加 23.5%，显着高于已故供体移植受者中除 HLA-A 之外的所有基因座 (23.1%)。非裔美国人已故捐献者移植受者比西班牙裔和白人受者更有可能患上 HLA-DQ UA-PD；在活体捐赠者移植受者中，与白人受者相比，非裔美国人或西班牙裔受者这样做的可能性明显更高。评估 HLA-DR/DQ 错配之间相互作用的模型揭示了 HLA-DQ 错配对 HLA-DQ UA-PD 的影响很大程度上是独立的。

HLA-DQ 错配与 UA-PD 的关联性最强，这种影响在非裔美国人和西班牙裔接受者中最为明显。 HLA-DQ UA-PD 引起的 cPRA 增加与任何其他 HLA 基因座相当或更大。这表明需要考虑 HLA-DQ 在肾脏分配中的影响。