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Bekbolsynov D, Mierzejewska B, Borucka J, Liwski RS, Greenshields AL, Breidenbach J, Gehring B, Leonard-Murali S, Khuder SA, Rees M, Green RC, Stepkowski SM. Low Hydrophobic Mismatch Scores Calculated for HLA-A/B/DR/DQ Loci Improve Kidney Allograft Survival. Front Immunol 2020; 11:580752. [PMID: 33193383 PMCID: PMC7659444 DOI: 10.3389/fimmu.2020.580752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/02/2020] [Indexed: 12/17/2022] Open
Abstract
We evaluated the impact of human leukocyte antigen (HLA) disparity (immunogenicity; IM) on long-term kidney allograft survival. The IM was quantified based on physicochemical properties of the polymorphic linear donor/recipient HLA amino acids (the Cambridge algorithm) as a hydrophobic, electrostatic, amino acid mismatch scores (HMS\AMS\EMS) or eplet mismatch (EpMM) load. High-resolution HLA-A/B/DRB1/DQB1 types were imputed to calculate HMS for primary/re-transplant recipients of deceased donor transplants. The multiple Cox regression showed the association of HMS with graft survival and other confounders. The HMS integer 0–10 scale showed the most survival benefit between HMS 0 and 3. The Kaplan–Meier analysis showed that: the HMS=0 group had 18.1-year median graft survival, a 5-year benefit over HMS>0 group; HMS ≤ 3.0 had 16.7-year graft survival, a 3.8-year better than HMS>3.0 group; and, HMS ≤ 7.8 had 14.3-year grafts survival, a 1.8-year improvement over HMS>7.8 group. Stratification based on EMS, AMS or EpMM produced similar results. Additionally, the importance of HLA-DR with/without -DQ IM for graft survival was shown. In our simulation of 1,000 random donor/recipient pairs, 75% with HMS>3.0 were re-matched into HMS ≤ 3.0 and the remaining 25% into HMS≥7.8: after re-matching, the 13.5 years graft survival would increase to 16.3 years. This approach matches donors to recipients with low/medium IM donors thus preventing transplants with high IM donors.
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Affiliation(s)
- Dulat Bekbolsynov
- Department of Medical Microbiology and Immunology, University of Toledo, Toledo, OH, United States
| | - Beata Mierzejewska
- Department of Medical Microbiology and Immunology, University of Toledo, Toledo, OH, United States
| | | | - Robert S Liwski
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | | | - Joshua Breidenbach
- Department of Medical Microbiology and Immunology, University of Toledo, Toledo, OH, United States
| | - Bradley Gehring
- Department of Medical Microbiology and Immunology, University of Toledo, Toledo, OH, United States
| | | | - Sadik A Khuder
- Department of Medicine and Public Health, University of Toledo, Toledo, OH, United States
| | - Michael Rees
- Department of Medical Microbiology and Immunology, University of Toledo, Toledo, OH, United States.,Department of Urology, University of Toledo College of Medicine, Toledo, OH, United States.,The Alliance for Paired Donation, Maumee, OH, United States
| | - Robert C Green
- Department of Computer Science, Bowling Green State University, Bowling Green, OH, United States
| | - Stanislaw M Stepkowski
- Department of Medical Microbiology and Immunology, University of Toledo, Toledo, OH, United States
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