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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
Preformed vs de novo anti-human leukocyte antigens-DQ antibodies in kidney transplantation: A retrospective study
Oumaima Guissouss, Khalid Achiaou, Joumana El Turk, Asmaa Mourachid, Abdelhadi Cheggali, Ghislaine Medkouri, Benyounes Ramdani, Mohammed Benghanem Gharbi, Majda Taoudi Benchekroun, Siham Bennani
Oumaima Guissouss, Majda Taoudi Benchekroun, Faculty of Sciences Ain Chock, Laboratory of Integrative Biology, University Hassan II, Casablanca 20100, Morocco
Oumaima Guissouss, Khalid Achiaou, Siham Bennani, Histocompatibility Laboratory, Institute Pasteur of Morocco, Casablanca 20360, Morocco
Joumana El Turk, Faculty of Health Sciences, Health Sciences Research Laboratory, International University of Casablanca, Casablanca 50169, Morocco
Asmaa Mourachid, Abdelhadi Cheggali, Ghislaine Medkouri, Benyounes Ramdani, Mohammed Benghanem Gharbi, Department of Nephrology, Dialysis, and Kidney Transplantation, Ibn Rochd University Hospital Center, Casablanca 20250, Morocco
Author contributions: Guissouss O designed the study, collected and analyzed immunological data, and drafted the manuscript; Achiaou K and El Turk J critically revised the manuscript for important intellectual content; Mourachid A and Cheggali A collected and interpreted clinical data; Medkouri G, Ramdani B, and Benghanem Gharbi M contributed to patient follow-up and provided clinical expertise; Taoudi Benchekroun M and Bennani S supervised the study design, provided critical revisions, and approved the final version.
Supported by the National Science and Technology Research Center (Morocco) “PhD-Associate Scholarship - PASS” Program, No. 88UH2C2023.
Institutional review board statement: This retrospective study was conducted in accordance with the principles of the Declaration of Helsinki. Clinical and immunological data were collected from patient records within the framework of the routine collaboration between the Human Leukocyte Antigen Laboratory of the Institute Pasteur of Morocco and the Department of Nephrology of Centre Hospitalier Universitaire de Casablanca (Morocco). All data were fully anonymized prior to analysis, and no patient identifiable information was used. The study was submitted to the Ethics Committee of Centre Hospitalier Universitaire de Casablanca, which confirmed that formal Institutional Review Board approval was not required for this retrospective study based on anonymized data.
Informed consent statement: Patient informed consent was waived by the Ethics Committee of Centre Hospitalier Universitaire de Casablanca (Morocco), because the study relied exclusively on anonymized retrospective data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data supporting the findings of this study are not publicly available due to patient confidentiality.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Oumaima Guissouss, PhD, Faculty of Sciences Ain Chock, Laboratory of Integrative Biology, University Hassan II, El Jadida Road, Casablanca 20100, Morocco.
oumayma.guissouss1@gmail.com
Received: September 11, 2025
Revised: September 30, 2025
Accepted: December 3, 2025
Published online: March 18, 2026
Processing time: 125 Days and 17.8 Hours
BACKGROUND
Donor-specific antibodies (DSAs) against human leukocyte antigen (HLA)-DQ are increasingly recognized as major contributors to antibody-mediated rejection (AMR) and graft failure in kidney transplantation. However, their clinical impact remains understudied in Morocco.
AIM
To evaluate the presence and implications of anti-HLA-DQ DSAs in Moroccan kidney transplant recipients.
METHODS
We retrospectively analyzed the immunological profiles and clinical outcomes of kidney transplant recipients screened for anti-HLA antibodies between 2015 and 2020, who developed anti-HLA-DQ DSAs either before or after transplantation. Anti-HLA antibodies were identified using Luminex® single antigen bead technology, and clinical follow-up included graft function assessment, biopsy interpretation, and evaluation of immunosuppression.
RESULTS
In the pre-transplant group (n = 6 with confirmed donor typing), patients with low to moderate median fluorescence intensity (MFI) anti-HLA-DQ DSAs (MFI 561-1581) underwent successful transplantation and maintained stable graft function under optimized immunosuppression. In contrast, in the post-transplant group (n = 6 with confirmed donor typing), the emergence of de novo anti-HLA-DQ DSAs was consistently associated with AMR, with MFI values reaching up to 19473, with biopsy-proven AMR in 5 of 6 cases and suspicion of AMR in 1 case. Two representative cases are detailed to illustrate the clinical impact of DQ DSAs: one patient developed high-level anti-DQB1*02 de novo DSA (MFI 12029) with persistent AMR after 5 years, while another developed anti-DQA1*05: 01 de novo DSA after an early AMR episode but maintained stable graft function after 5 years (creatinine 1.48 mg/dL).
CONCLUSION
Our findings underscore the clinical significance of anti-HLA-DQ DSAs in Moroccan kidney transplant recipients. While preformed DSAs with low immunogenicity may permit successful transplantation, de novo DSAs strongly correlate with AMR. Proactive monitoring, including routine DSA screening and HLA-DQ typing, could improve graft outcomes by enabling early intervention and better donor selection.
Core Tip: This retrospective study highlights the emerging role of donor-specific anti- human leukocyte antigen (HLA)-DQ antibodies in kidney transplantation, an area where evidence from Moroccan populations remains scarce. Individual cases illustrate the clinical spectrum, but the findings derive from a systematic retrospective analysis. The study highlights the association between anti-HLA-DQ antibodies, antibody-mediated rejection, and graft outcomes, underscoring the need to integrate HLA-DQ monitoring into routine post-transplant follow-up and offering a valuable perspective for improving patient management in resource-limited settings.
