Leeaphorn N, et al. - Given that HLA epitope-mismatching at HLA-DQ loci has been shown to be associated with the development of anti-DQ donor-specific antibodies and adverse graft outcomes, researchers examined the clinical significance of broad antigen HLA-DQ mismatching for graft outcomes. They extracted data from the United Network Organ Sharing/the Organ Procurement and Transplantation Network (UNOS/OPTN) for patients with primary kidney transplants performed between 2005 and 2014. Patients were grouped as having either zero HLA-DQ mismatches, or one or two HLA-DQ mismatches. HLA-DQ mismatching was found to be related to lower graft survival independent of HLA-ABDR in living donor kidney transplants and deceased donor kidney transplants with cold ischemia time ≤17 hours. Furthermore, an association of HLA-DQ mismatching with a higher 1-year risk of acute rejection was observed in living and deceased donor kidney transplants.