HLA 错配对肾移植后非霍奇金淋巴瘤发生率的影响。

Impact of HLA mismatching on incidence of posttransplant non-hodgkin lymphoma after kidney transplantation.

机构信息

Department of Transplantation Immunology, University of Heidelberg, Im Neuenheimer Feld 305, D-61920 Heidelberg, Germany.

出版信息

Transplantation. 2010 Mar 15;89(5):567-72. doi: 10.1097/TP.0b013e3181c69855.

DOI:10.1097/TP.0b013e3181c69855

PMID:20110857

Abstract

BACKGROUND

Posttransplant non-Hodgkin lymphoma is a rare complication but associated with high mortality. The extent to which human leukocyte antigen (HLA) mismatching influences the rate of posttransplant lymphoma has not been clarified.

METHODS

Data on lymphomas occurring in the first 3 years posttransplant were analyzed among first kidney transplants from deceased donors performed between 1985 and 2007 and reported to the Collaborative Transplant Study.

RESULTS

Of 152,728 patients included, 593 non-Hodgkin lymphomas were diagnosed. Cox multivariate regression analysis showed that HLA-A mismatches had no influence on the rate of lymphoma. One and two HLA-DR mismatches were associated with a hazard ratio (HR) of 1.21 (95% confidence interval 1.00-1.45, P=0.047) and 1.56 (95% confidence interval 1.21-1.99, P<0.001), respectively. For lymphoma of the kidney and central nervous system, HRs for two HLA-DR mismatches were 2.29 (P=0.007) and 2.17 (P=0.029), respectively. Two HLA-B mismatches were also significantly associated with lymphoma in the kidney (HR 2.82, P=0.009).

CONCLUSION

Mismatches at the HLA-DR locus are a significant risk factor for posttransplant non-Hodgkin lymphoma, particularly in the kidney and central nervous system, whereas two HLA-B mismatches increase the risk for the development of lymphoma of the kidney.

摘要

背景

移植后非霍奇金淋巴瘤是一种罕见的并发症，但与高死亡率相关。人类白细胞抗原（HLA）错配程度对移植后淋巴瘤的发生率的影响尚未阐明。

方法

分析了 1985 年至 2007 年间进行的首次尸体供肾移植后 3 年内发生的淋巴瘤的数据，并将其报告给协作移植研究。

结果

在纳入的 152728 例患者中，诊断出 593 例非霍奇金淋巴瘤。Cox 多变量回归分析显示，HLA-A 错配对淋巴瘤的发生率没有影响。一个和两个 HLA-DR 错配的危险比（HR）分别为 1.21（95%置信区间 1.00-1.45，P=0.047）和 1.56（95%置信区间 1.21-1.99，P<0.001）。对于肾和中枢神经系统的淋巴瘤，两个 HLA-DR 错配的 HR 分别为 2.29（P=0.007）和 2.17（P=0.029）。两个 HLA-B 错配也与肾淋巴瘤显著相关（HR 2.82，P=0.009）。