HLA Eplet Mismatch and Donor Specific Antibodies in Kidney Transplantation

S. Wan,^1,2 S. Angel de Wilde,² B. Rosales,² S. Chadban,^1,2 K. Wyburn.^1,2

¹Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
²Sydney Medical School, University of Sydney, Sydney, Australia.

Meeting: 2018 American Transplant Congress

Abstract number: 512

Keywords: Epitopes, HLA antibodies, HLA matching, Kidney transplantation

Session Information

Session Name: Concurrent Session: Kidney Complications: Antibody & Late Outcomes

Session Type: Concurrent Session

Date: Tuesday, June 5, 2018

Session Time: 4:30pm-6:00pm

Presentation Time: 5:18pm-5:30pm

Location: Room 4B

BACKGROUND: Although HLA matching improves graft survival in kidney transplant recipients (KTx), eplet mismatches provide higher resolution information, and could better predict the development of donor specific antibodies (DSA). Currently, limited prospective data exist on the association between eplet mismatch and DSA.

AIM: To assess the relationship between eplet mismatch and DSA.

METHODS: We calculated the number of HLA-A, B, C, DR and DQ eplet mismatches in a prospective cohort of KTx transplanted between July 2010 and August 2017. Where possible, high resolution (4-digit) donor and recipient typing was entered into HLA Matchmaker to calculate the number of eplet mismatches. Where high resolution typing was not available, the HLA Matchmaker Converter program was used to convert 2-digit typing to 4-digit typing prior to calculation of mismatches. All patients were prospectively screened for DSA pretransplant and at 3 and 12 months post-transplant. The association between eplet mismatch, DSA and clinical outcomes was assessed using multivariable analysis.

RESULTS: Of 313 patients transplanted during the study period, high resolution typing or conversion was completed for 202 recipients, 253 donors and 166 donor-recipient pairs. Conversion of low to high resolution typing was limited by the absence of ethnicity (n=83) or haplotype (n=64) data in the Converter database for 147 patients (47%). Of the 166 pairs with eplet mismatch data, DSA screening was complete for 150 patients. There was a mean of 14 (SD 7.7) Class I and 17 (SD 11.8) Class II eplet mismatches per patient (Table 1). 64 patients (43%) had pretransplant DSA (preDSA), 30 (20%) had de novo DSA (dnDSA) and 17 (11%) had both pre- and dnDSA. The number of HLA-A, B, C and DR eplet mismatches was associated with detection of preDSA (OR 1.04; 95% CI 1.01-1.07; P=0.007), however there was no association between HLA-DQ eplet mismatches and preDSA. There was no association between eplet mismatches and dnDSA.

CONCLUSION: Calculated HLA-A, B, C and DR eplet mismatches were associated with pretransplant DSA but not dnDSA.

CITATION INFORMATION: Wan S., Angel de Wilde S., Rosales B., Chadban S., Wyburn K. HLA Eplet Mismatch and Donor Specific Antibodies in Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Wan S, Wilde SAngelde, Rosales B, Chadban S, Wyburn K. HLA Eplet Mismatch and Donor Specific Antibodies in Kidney Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/hla-eplet-mismatch-and-donor-specific-antibodies-in-kidney-transplantation/. Accessed May 11, 2025.

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