Cross-organ hierarchy of HLA molecular mismatches in donor-specific antibody development in solid organ transplantations
Donor-specific antibodies (DSAs) against human leukocyte antigen (HLA) play a crucial role in antibody-mediated rejection, a major barrier to successful organ transplantation. Donor-recipient HLA molecular incompatibility critically influences DSA susceptibility, commonly assessed by analyzing mismatches in the HLA eplet repertoire. This study, including six distinct liver, lung, and kidney transplant cohorts from two centers (978 donor-recipient pairs), explores associations between individual eplet mismatches and DSA development. Certain mismatched eplets are strongly linked to DSA development, while others show weaker associations, a trend consistent across different organ types. Machine learning leverages these hierarchical associations to develop an eplet risk score (ERS), outperforming traditional eplet mismatch assessments. Furthermore, T cell proliferation in mixed lymphocyte reaction in vitro correlates with the ERS, attenuated by antibody-mediated inhibition of a mismatched DSA-associated eplet. These results establish the differential immunological impacts of mismatched HLA eplets as integral in clinical practice and therapeutic innovation.
Authors
- Atsushi Kawaguchi (ORCID: https://orcid.org/0000-0002-5485-1578)
- Takashi Ito (ORCID: https://orcid.org/0000-0002-5892-8317)
- Kazuto Tsukita (ORCID: https://orcid.org/0000-0002-6878-2155)
- Kenji Nakamura (ORCID: https://orcid.org/0000-0003-0135-7821)
- Satona Tanaka (ORCID: https://orcid.org/0000-0002-0789-2350)
- Tomonori Habuchi (ORCID: https://orcid.org/0000-0003-0998-4432)
- Nobuhiro Fujiyama (ORCID: https://orcid.org/0000-0001-9411-2254)
- Hidenao Kayawake (ORCID: https://orcid.org/0000-0003-2357-7024)
- Shintaro Yagi (ORCID: https://orcid.org/0000-0001-7465-5761)
- Etsuro Hatano (ORCID: https://orcid.org/0000-0003-3407-1918)
- Hiroshi Date (ORCID: https://orcid.org/0000-0001-7262-6000)
- Masaaki Hirata (ORCID: https://orcid.org/0000-0003-4248-3568)
- Mitsuru Saito (ORCID: https://orcid.org/0000-0003-1653-4309)
- Takero Shindo (ORCID: https://orcid.org/0000-0002-2085-6151)
- Arisa Kato
- Takashi Kobayashi
- Rie Hishida
- Ryo Fujimoto (ORCID: https://orcid.org/0000-0001-9595-9350)
- Kimiko Yurugi
Institutions
- Kanazawa University (JP)
- Saga University (JP)
- Akita University (JP)
- Kyoto University (JP)
- Akita University Hospital (JP)
- Kyoto University Hospital (JP)
Publication Details
- Journal
- Cell Reports Medicine
- Published
- 2025-05-30
- DOI
- https://doi.org/10.1016/j.xcrm.2025.102153
- Primary Topic
- Renal Transplantation Outcomes and Treatments
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Japan Agency for Medical Research and Development
- Japan Society for the Promotion of Science