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Impact of human leukocyte antigen mismatch on lung transplant outcome.
Interact Cardiovasc Thorac Surg. 2018 05 01; 26(5):859-864.IC

Abstract

OBJECTIVES

Human leucocyte antigen (HLA) mismatch between donor and recipient has a differential impact on the outcome after transplant (Tx) among transplantable solid organs. Although the lung is considered a highly antigenic organ, the impact of HLA matching between the donor and the recipient has been shown to be heterogeneous on lung Tx outcome. To provide further evidence that HLA matching should be considered in the decision process prior to lung Tx, we evaluated the impact of donor/recipient HLA mismatch on the outcome after lung Tx at our institution.

METHODS

All patients who underwent lung Tx were analysed in this retrospective single-cohort study between 1994 and 2013 for HLA (-A, -B or -DR) matching between the donor and the recipient and their association with overall survival, the incidence of acute cellular rejection (ACR) and the development of chronic lung allograft dysfunction (CLAD).

RESULTS

In total, 371 (197 men) patients were included. Of these, 117 patients had no HLA match (0/6), 143 had a 1/6 match, 77 had 2/6 matches, 28 had 3/6 matches and 6 had 4/6 matches. One hundred and twenty-two (33%) patients experienced at least 1 episode of ACR and 172 (46%) patients developed CLAD. Univariate analysis showed a significant correlation between HLA mismatch and the development of CLAD, whereas multivariate analysis revealed that the number of HLA matches (hazard ratio 0.76; P = 0.002), antibodies to cytomegalovirus in either donors or recipients (hazard ratio 1.52; P = 0.036) and donor age (hazard ratio 1.03; P < 0.001) were independent risk factors for the development of CLAD. On the other hand, HLA matches did not correlate with the incidence of ACR and with the overall survival rate.

CONCLUSIONS

The number of HLA mismatches between donors and recipients after lung Tx did not correlate with ACR or with the overall survival. In contrast, HLA mismatch correlated with the development of CLAD and should therefore be considered a risk factor.

Authors+Show Affiliations

Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland.Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland.Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29300898

Citation

Yamada, Yoshito, et al. "Impact of Human Leukocyte Antigen Mismatch On Lung Transplant Outcome." Interactive Cardiovascular and Thoracic Surgery, vol. 26, no. 5, 2018, pp. 859-864.
Yamada Y, Langner T, Inci I, et al. Impact of human leukocyte antigen mismatch on lung transplant outcome. Interact Cardiovasc Thorac Surg. 2018;26(5):859-864.
Yamada, Y., Langner, T., Inci, I., Benden, C., Schuurmans, M., Weder, W., & Jungraithmayr, W. (2018). Impact of human leukocyte antigen mismatch on lung transplant outcome. Interactive Cardiovascular and Thoracic Surgery, 26(5), 859-864. https://doi.org/10.1093/icvts/ivx412
Yamada Y, et al. Impact of Human Leukocyte Antigen Mismatch On Lung Transplant Outcome. Interact Cardiovasc Thorac Surg. 2018 05 1;26(5):859-864. PubMed PMID: 29300898.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of human leukocyte antigen mismatch on lung transplant outcome. AU - Yamada,Yoshito, AU - Langner,Tim, AU - Inci,Ilhan, AU - Benden,Christian, AU - Schuurmans,Macé, AU - Weder,Walter, AU - Jungraithmayr,Wolfgang, PY - 2017/06/18/received PY - 2017/11/12/accepted PY - 2018/1/5/pubmed PY - 2019/4/11/medline PY - 2018/1/5/entrez SP - 859 EP - 864 JF - Interactive cardiovascular and thoracic surgery JO - Interact Cardiovasc Thorac Surg VL - 26 IS - 5 N2 - OBJECTIVES: Human leucocyte antigen (HLA) mismatch between donor and recipient has a differential impact on the outcome after transplant (Tx) among transplantable solid organs. Although the lung is considered a highly antigenic organ, the impact of HLA matching between the donor and the recipient has been shown to be heterogeneous on lung Tx outcome. To provide further evidence that HLA matching should be considered in the decision process prior to lung Tx, we evaluated the impact of donor/recipient HLA mismatch on the outcome after lung Tx at our institution. METHODS: All patients who underwent lung Tx were analysed in this retrospective single-cohort study between 1994 and 2013 for HLA (-A, -B or -DR) matching between the donor and the recipient and their association with overall survival, the incidence of acute cellular rejection (ACR) and the development of chronic lung allograft dysfunction (CLAD). RESULTS: In total, 371 (197 men) patients were included. Of these, 117 patients had no HLA match (0/6), 143 had a 1/6 match, 77 had 2/6 matches, 28 had 3/6 matches and 6 had 4/6 matches. One hundred and twenty-two (33%) patients experienced at least 1 episode of ACR and 172 (46%) patients developed CLAD. Univariate analysis showed a significant correlation between HLA mismatch and the development of CLAD, whereas multivariate analysis revealed that the number of HLA matches (hazard ratio 0.76; P = 0.002), antibodies to cytomegalovirus in either donors or recipients (hazard ratio 1.52; P = 0.036) and donor age (hazard ratio 1.03; P < 0.001) were independent risk factors for the development of CLAD. On the other hand, HLA matches did not correlate with the incidence of ACR and with the overall survival rate. CONCLUSIONS: The number of HLA mismatches between donors and recipients after lung Tx did not correlate with ACR or with the overall survival. In contrast, HLA mismatch correlated with the development of CLAD and should therefore be considered a risk factor. SN - 1569-9285 UR - https://www.unboundmedicine.com/medline/citation/29300898/Impact_of_human_leukocyte_antigen_mismatch_on_lung_transplant_outcome_ L2 - https://academic.oup.com/icvts/article-lookup/doi/10.1093/icvts/ivx412 DB - PRIME DP - Unbound Medicine ER -