Tags

Type your tag names separated by a space and hit enter

HLA mismatches influence lung transplant recipient survival, bronchiolitis obliterans and rejection: implications for donor lung allocation.
J Heart Lung Transplant. 2011 Apr; 30(4):426-34.JH

Abstract

BACKGROUND

Human leukocyte antigen (HLA) histocompatibility is not considered when placing donor allografts for lung transplantation. We previously reported that fewer individual Class I (HLA-A and -B) and Class II (HLA-DR) antigen mismatches (MM) correlated with improved survival in lung transplant recipients. In this study we evaluated whether the effects of total HLA, Class I and Class II MM were more important determinants of: (1) recipient survival; (2) development of bronchiolitis obliterans (BO); and (3) freedom from acute rejection (AR).

METHODS

All adult primary cadaveric lung recipients transplanted between April 1, 1994, and June 30, 2004 entered in the OPTN database were included (n = 9,791). Groups were created based on the total number of HLA, Class I and Class II MM. Recipient survival, freedom from AR and freedom from BO were compared. Univariate data were computed using the Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using the Cox proportional hazards method.

RESULTS

Univariate analysis identified significantly improved survival in recipients with fewer total HLA (p < 0.001) and Class I MM (p = 0.005). The incidence of BO was significantly lower in patients with fewer total Class I MM (p = 0.036). AR was influenced only by Class II MM (p = 0.005). By multivariate analysis, total HLA, Class I and Class II MM impacted recipient survival. Total HLA and Class I MM correlated with development of BO. Class II MM correlated with development of AR.

CONCLUSION

HLA MM are important determinants of lung transplant survival, BO and AR. These data suggest that donor-recipient HLA MM may warrant consideration when allocating organs for lung transplantation.

Authors+Show Affiliations

Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center at Dallas, TX 75390, USA. matthias.peltz@utsouthwestern.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21145259

Citation

Peltz, Matthias, et al. "HLA Mismatches Influence Lung Transplant Recipient Survival, Bronchiolitis Obliterans and Rejection: Implications for Donor Lung Allocation." The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, vol. 30, no. 4, 2011, pp. 426-34.
Peltz M, Edwards LB, Jessen ME, et al. HLA mismatches influence lung transplant recipient survival, bronchiolitis obliterans and rejection: implications for donor lung allocation. J Heart Lung Transplant. 2011;30(4):426-34.
Peltz, M., Edwards, L. B., Jessen, M. E., Torres, F., & Meyer, D. M. (2011). HLA mismatches influence lung transplant recipient survival, bronchiolitis obliterans and rejection: implications for donor lung allocation. The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation, 30(4), 426-34. https://doi.org/10.1016/j.healun.2010.10.005
Peltz M, et al. HLA Mismatches Influence Lung Transplant Recipient Survival, Bronchiolitis Obliterans and Rejection: Implications for Donor Lung Allocation. J Heart Lung Transplant. 2011;30(4):426-34. PubMed PMID: 21145259.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HLA mismatches influence lung transplant recipient survival, bronchiolitis obliterans and rejection: implications for donor lung allocation. AU - Peltz,Matthias, AU - Edwards,Leah B, AU - Jessen,Michael E, AU - Torres,Fernando, AU - Meyer,Dan M, Y1 - 2010/12/08/ PY - 2010/02/24/received PY - 2010/10/13/revised PY - 2010/10/22/accepted PY - 2010/12/15/entrez PY - 2010/12/15/pubmed PY - 2011/8/19/medline SP - 426 EP - 34 JF - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation JO - J. Heart Lung Transplant. VL - 30 IS - 4 N2 - BACKGROUND: Human leukocyte antigen (HLA) histocompatibility is not considered when placing donor allografts for lung transplantation. We previously reported that fewer individual Class I (HLA-A and -B) and Class II (HLA-DR) antigen mismatches (MM) correlated with improved survival in lung transplant recipients. In this study we evaluated whether the effects of total HLA, Class I and Class II MM were more important determinants of: (1) recipient survival; (2) development of bronchiolitis obliterans (BO); and (3) freedom from acute rejection (AR). METHODS: All adult primary cadaveric lung recipients transplanted between April 1, 1994, and June 30, 2004 entered in the OPTN database were included (n = 9,791). Groups were created based on the total number of HLA, Class I and Class II MM. Recipient survival, freedom from AR and freedom from BO were compared. Univariate data were computed using the Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using the Cox proportional hazards method. RESULTS: Univariate analysis identified significantly improved survival in recipients with fewer total HLA (p < 0.001) and Class I MM (p = 0.005). The incidence of BO was significantly lower in patients with fewer total Class I MM (p = 0.036). AR was influenced only by Class II MM (p = 0.005). By multivariate analysis, total HLA, Class I and Class II MM impacted recipient survival. Total HLA and Class I MM correlated with development of BO. Class II MM correlated with development of AR. CONCLUSION: HLA MM are important determinants of lung transplant survival, BO and AR. These data suggest that donor-recipient HLA MM may warrant consideration when allocating organs for lung transplantation. SN - 1557-3117 UR - https://www.unboundmedicine.com/medline/citation/21145259/HLA_mismatches_influence_lung_transplant_recipient_survival_bronchiolitis_obliterans_and_rejection:_implications_for_donor_lung_allocation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-2498(10)00674-1 DB - PRIME DP - Unbound Medicine ER -