Impact of Human Leukocyte Antigen mismatch on lung transplant outcome

Hintergrund:

Human Leukocyte Antigen (HLA) mismatch between donor (D) and recipient (R) is of differential impact on the outcome after transplantation (Tx) among transplantable solid organs. Although the lung is considered a particularly highly antigenic organ, the impact of HLA matching between D and R has been shown to be heterogeneous on lung Tx outcome. To provide further evidence if HLA matching should be included into the decision process prior to lung Tx, we here evaluated the impact of D/R HLA-mismatch on outcome after lung Tx.

Material und Methode:

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

Ergebnis:

In total, 371 patients (197 males) were included. Of these, 117 patients had no HLA match (0/6), 143 had 1/6 match, 77 had 2/6 matches, 28 had 3/6 matches and 6 had 4/6 matches. 122 patients (32.9%) experienced at least one episode of ACR and 172 patients (46.4%) developed CLAD. Univariate analyses showed a significant correlation between HLA mismatch and the incidence of CLAD, while multivariate analysis revealed that the number of HLA matches (HR0.76; p = 0.002), cytomegalovirus-antibody in either donors or recipients (HR 1.52; p = 0.036) and donor age (HR 1.03; p < 0.001) were independent factors for CLAD development. On the other hand, HLA matches did not correlate with the incidence of ACR and OS.

Schlussfolgerung:

The number of HLA mismatches between D and R after lung Tx did not correlate with a higher incidence of ACR or OS. In contrast, the number of HLA mismatches correlated with the incidence of CLAD and should therefore be considered a risk factor.