HLA-DR and -DQ eplet mismatches and transplant glomerulopathy: a nested case-control study

Am J Transplant. 2015 Jan;15(1):137-48. doi: 10.1111/ajt.12968. Epub 2014 Dec 17.


We conducted a nested case-control study from a cohort of adult kidney transplant recipients to assess the risk of transplant glomerulopathy (TG) as a function of donor and recipient HLA-DR and -DQ incompatibility at the eplet level. Cases (n = 52) were defined as patients diagnosed with transplant glomerulopathy based on biopsies showing glomerular basement membrane duplication without immune complex deposition. Controls (n = 104) with a similar follow-up from transplantation were randomly selected from the remaining cohort. HLAMatchmaker was used to ascertain the number of DRB1/3/4/5, DQA1 and DQB1 related eplet mismatches (eplet load). Multivariable conditional logistic regression models demonstrated an increase in the odds of TG (odds ratios [OR] of 2.84 [95% confidence interval (CI): 1.03, 7.84] and 4.62 [95% CI: 1.51, 14.14]) in the presence of 27-43 and >43 HLA-DR + DQ related eplet mismatches versus <27 eplet mismatches, respectively. When the eplet load was modeled as a continuous variable, the OR for TG was 1.25 (95% CI: 1.04, 1.50) for every 10 additional HLA-DR + DQ eplet mismatches. Our study suggests that minimization of HLA-DR + DQ eplet mismatches may decrease the incidence of transplant glomerulopathy diagnosed by indication biopsies. The role of eplet immunogenicity/antigenicity as determinants of allograft outcomes requires further study.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Glomerulonephritis, Membranous / etiology*
  • Glomerulonephritis, Membranous / immunology
  • Graft Rejection / diagnosis
  • Graft Rejection / etiology
  • Graft Survival
  • HLA-DQ Antigens / immunology*
  • HLA-DR Antigens / immunology*
  • Histocompatibility / immunology*
  • Humans
  • Kidney Failure, Chronic / immunology
  • Kidney Failure, Chronic / surgery*
  • Kidney Function Tests
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Prognosis
  • Risk Factors
  • Transplant Recipients
  • Transplantation, Homologous


  • HLA-DQ Antigens
  • HLA-DR Antigens