DQB1 antigen matching improves rejection-free survival in pediatric heart transplant recipients

J Heart Lung Transplant. 2024 May;43(5):816-825. doi: 10.1016/j.healun.2024.01.008. Epub 2024 Jan 15.


Background: Presence of donor-specific antibodies (DSAs), particularly to class II antigens, remains a major challenge in pediatric heart transplantation. Donor-recipient human leukocyte antigen (HLA) matching is a potential strategy to mitigate poor outcomes associated with DSAs. We evaluated the hypothesis that antigen mismatching at the DQB1 locus is associated with worse rejection-free survival.

Methods: Data were collected from Scientific Registry of Transplant Recipients for all pediatric heart transplant recipients 2010-2021. Only transplants with complete HLA typing at the DQB1 locus for recipient and donor were included. Primary outcome was rejection-free graft survival through 5 years.

Results: Of 5,115 children, 4,135 had complete DQB1 typing and were included. Of those, 503 (12%) had 0 DQB1 donor-recipient mismatches, 2,203 (53%) had 1, and 1,429 (35%) had 2. Rejection-free survival through 5 years trended higher for children with 0 DQB1 mismatches (68%), compared to those with 1 (62%) or 2 (63%) mismatches (pairwise p = 0.08 for both). In multivariable analysis, 0 DQB1 mismatches remained significantly associated with improved rejection-free graft survival compared to 2 mismatches, while 1 DQB1 mismatch was not. Subgroup analysis showed the strongest effect in non-Hispanic Black children and those undergoing retransplant.

Conclusions: Matching at the DQB1 locus is associated with improved rejection-free survival after pediatric heart transplant, particularly in Black children, and those undergoing retransplant. Assessing high-resolution donor typing at the time of allocation may further corroborate and refine this association. DQB1 matching may improve long-term outcomes in children stabilized either with optimal pharmacotherapy or supported with durable devices able to await ideal donors.

Keywords: HLA matching; antibody-mediated rejection; disparities; pediatric heart transplant; rejection.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Graft Rejection* / immunology
  • Graft Survival* / immunology
  • HLA-DQ beta-Chains* / genetics
  • Heart Transplantation*
  • Histocompatibility Testing / methods
  • Humans
  • Infant
  • Male
  • Registries
  • Retrospective Studies
  • Tissue Donors
  • Transplant Recipients


  • HLA-DQ beta-Chains
  • HLA-DQB1 antigen