A Influência do HLA-DP no Transplante Renal: Uma Revisão Sistemática

Kidney transplantation is the treatment of choice for end-stage renal disease, with HLA compatibility being a key determinant of graft outcomes. Although other HLA loci are routinely evaluated, the clinical impact of HLA-DP has not yet been fully elucidated. This systematic review aimed to assess the role of HLA-DP as a predictor of kidney transplant outcomes, including rejection, graft survival and loss, development of donor-specific antibodies (DSAs), and renal function. The review was conducted in accordance with PRISMA guidelines and included observational studies involving adult kidney transplant recipients that evaluated HLA-DP mismatches, DSA presence, expression levels, and clinical outcomes. Literature searches were performed in PubMed, Embase, and Lilacs databases, and methodological quality was assessed using the Newcastle–Ottawa Scale. Due to data heterogeneity, results were synthesized using a narrative approach. Seven studies were included. The presence of preformed anti–HLA-DP DSAs was independently associated with antibody-mediated acute rejection, with an impact comparable to that observed for HLA-DR and HLA-DQ. A higher burden of molecular incompatibilities was associated with poorer graft survival and accelerated decline in renal function, even in the presence of low-intensity antibodies. In conclusion, HLA-DP has significant clinical relevance in kidney transplant outcomes, underscoring the need for more detailed immunological assessment of this locus.