*Purpose: De-novo anti-HLA-DQ donor-specific antibody (DSA) has been identified as a risk factor for late graft dysfunction and graft loss in kidney transplantation (KT). The impact of preformed anti-HLA-DQ DSA has been discussed, but it has not been established yet. This study aimed to investigate the clinical significance of preformed anti-HLA-DQ DSA on graft outcomes.

*Methods: We evaluated 982 recipients who underwent kideny transplantation at Seoul St. Mary’s Hospital from January 2010 to December 2018. According to results of DSA using luminex single antigen bead assay, recipients were classified as no DSA group, only DQ group and non-DQ group. Primary outcome was the incidence of biopsy-proven acute antibody-mediated rejection (AMR).

*Results: Recipients were classified as no DSA (903 recipients, 91.9 %), only DQ (23 recipients, 2.3 %) and non-DQ (56 recipients, 5.7 %). The only DQ and non-DQ groups had significantly higher the incidence of acute AMR compared to no DSA group (p < 0.05, for both). There were no significant differences in the death-censored graft loss rate and mortaliy between groups. In multivariate logistic regression analysis, the presence of preformed anti-HLA DQ DSA or anti-non-HLA DQ, and 4 or more of HLA mismatch number were risk factors associated with acute AMR (anti-HLA DQ DSA: HR 3.23; CI 95 %, p = 0.040, anti-non-HLA DQ: HR 6.63; CI 95 %, p < 0.001, HLA mismatch number ≥ 4: HR 1.72; CI 95 %, p = 0.029, respectively). In Kaplan-Meier analysis for cumulative incidence of acute AMR, the incidences of acute AMR of only DQ and non-DQ groups were significantly higher than no DSA group (p = 0.010 and p < 0.001, respectively).

*Conclusions: Preformed anti-HLA DQ DSA could affect the development of acute rejection, especially acute ABMR, as much as anti-HLA A, B and DR DSA. The identification of preformed anti-HLA DQ DSA can help improve allograft outcomes.

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