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Original Article

Korean J Transplant 2019; 33(3): 47-54

Published online September 30, 2019


© The Korean Society for Transplantation

Clinical significance of donor-specific anti-HLA-DR51/52/53 antibodies for antibody-mediated rejection in kidney transplant recipients

Borae Geum Park1,2, Younhee Park1, Dong Jin Joo3, Kyu Ha Huh3, Myoung Soo Kim3, Soon Il Kim3, Yu Seun Kim3, Hyon-Suk Kim1

1Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea;
2Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, Korea;
3Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Hyon-Suk Kim
Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
Tel: +82-2-2228-2443, Fax: +82-2-364-1583 E-mail: kimhs54@yuhs.ac

Received: March 14, 2019; Revised: August 12, 2019; Accepted: August 13, 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background: The presence of donor-specific antibodies (DSAs) to human leukocyte antigen (HLA) increases the risk of antibody-mediated rejection (ABMR) after kidney transplantation (KT). However, the clinical relevance of anti-HLA-DR51/52/53 antibodies remains unclear because of their weak antigen expression. This study evaluated the association between anti- HLA-DR51/52/53 DSAs and ABMR.
Methods: We retrospectively reviewed the single-antigen-bead panel reactive antibody (single PRA) results of 130 patients tested between August 1, 2009 and March 6, 2015, based on clinical necessity after allograft KT. Single PRA analysis was performed using Luminex assay kits (Lifecodes LSA class I and II). We reviewed the clinical course and biopsy results of patients with anti-HLA-DR51/52/53 DSAs.
Results: Post-KT DSAs were identified in 89 of the 130 patients (68.5%), with 26 of 32 class I DSAs and 63 of 66 class II DSAs being immunodominant DSAs. Thirteen patients had anti-HLA-DR51/52/53 DSAs. Three patients with anti-HLA-DR51/52/53 immunodominant DSAs alone were diagnosed with biopsy-proven ABMR. One patient who developed anti-HLA-DR DSA 13 days after KT showed a rapid increase in anti-HLA-DR51 DSA and had biopsy-proven ABMR.
Conclusions: Although the expression of the HLA-DR51/52/53 antigen was weak, anti-HLA-DR51/52/53 DSAs might be correlated with biopsy-proven ABMR. Therefore, anti-HLA-DR51/52/53 DSAs must be evaluated as a cause of ABMR after transplantation.

Keywords: Donor specific antibody, Antibody mediated rejection, Human leukocyte antigen