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

R. Sapir-Pichhadze, K. Tinckam, K. Quach, A. G. Logan, A. Laupacis, R. John, J. Beyene, S. J. Kim

Research output: Contribution to journalArticlepeer-review

77 Scopus citations


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. In this nested case-control study from a Canadian cohort of adult kidney transplant recipients, the number of HLA-DR and HLA-DQ related eplet mismatches is independently associated with the development of transplant glomerulopathy.

Original languageEnglish (US)
Pages (from-to)137-148
Number of pages12
JournalAmerican Journal of Transplantation
Issue number1
StatePublished - Jan 1 2015

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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