ORIGINAL RESEARCH article
Front. Nephrol.
Sec. Kidney Transplantation
This article is part of the Research TopicAlloimmunity in Kidney Transplantation: From Mechanisms to Clinical TranslationView all 3 articles
Effect of preexisting human leukocyte antigen donor-specific antibodies especially human leukocyte antigen-DQ on kidney transplant outcome
Provisionally accepted
- Medanta Super Speciality Hospital, Lucknow, India
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ABSTRACT Background: Anti-HLA-DQ donor-specific antibodies are increasingly recognized for their role in early rejection and compromised graft function following kidney transplantation. Methods: A total of 119 prospective kidney transplant recipients were evaluated for pre-transplant HLA sensitization using single-antigen bead (SAB) assays for class I and class II donor-specific antibodies (DSAs).. All patients had negative complement-dependent cytotoxicity (CDC) crossmatch results; however, flow cytometry crossmatch was positive for T cells in three patients and showed borderline B cell positivity in one patient. Of these, 100 patients proceeded to kidney transplantation, including 19 ABO-incompatible transplants. All recipients were followed for a minimum of four years post-transplant, and induction immunosuppression was administered using either anti-thymocyte globulin (ATG) or ATLG (Grafalon®). Results: A total 100 underwent kidney transplant, out of that, thirty-four recipients (34%) had class I HLA antibodies (MFI 9057-757); five had class I DSAs (MFI 2084-822) without any rejection episodes. Thirty-eight patients (38%) tested positive for class II HLA antibodies, including 20 with anti-HLA-DQ (MFI 7725–766); of these, eight had donor-specific anti-DQ antibodies. Only one patient, who underwent an ABO-incompatible transplant and had pre-transplant DQ DSA with MFI 7725, developed biopsy-proven antibody-mediated rejection (AMR) but recovered following treatment. All eight DQ DSA-positive recipients showed post-transplant MFI decline within one month. Rejection was notably infrequent in recipients who received Grafalon® induction. Conclusions: Preformed anti-HLA-DQ DSAs, especially with MFI >5000 and in the context of ABO incompatibility, may predispose to AMR. DQ DSAs with lower MFI require vigilant monitoring due to risk of post-transplant rebound. ATLG-based induction was associated with low rejection incidence and favorable short-term outcomes.
Keywords: Antibody-mediated Rejection, ATLG, donor-specific antibodies, HLA-DQ antibodies, Kidney Transplantation, Single antigen bead assay
Received: 29 Oct 2025; Accepted: 10 Feb 2026.
Copyright: © 2026 Mehrotra, Sharma, Kapoor, Jaiswal and Kapoor. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Raj Kumar Sharma
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