Interaction between HLA-B leader peptide variants and cytomegalovirus serostatus is associated with early T cell-mediated rejection in kidney transplantation

Mismatches between mature recipient and donor HLA proteins can trigger alloreactivity upon transplantation. Recent studies suggest that also the leader peptide of HLA class I alleles may affect the transplantation outcome. In this retrospective study, we examined the association between the HLA-B leader -21 methionine (M)/threonine (T) dimorphism and T cell-mediated rejection (TCMR) early after kidney transplantation. In a hypothesis-generating cohort of 351 transplants, -21MM recipients experienced significantly increased odds of early TCMR within the first 90 days post-transplantation compared to -21TT recipients (odds ratio (OR) 4.57, 95% confidence interval (CI) 1.87-10.95, p