Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center at Dallas, TX 75390, USA.
J Heart Lung Transplant. 2011 Apr;30(4):426-34. doi: 10.1016/j.healun.2010.10.005. Epub 2010 Dec 8.
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).
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.
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.
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.
在进行肺移植时，不考虑人类白细胞抗原（HLA）组织相容性。我们之前报道过，在肺移植受者中，个体Ⅰ类（HLA-A 和 -B）和Ⅱ类（HLA-DR）抗原错配（MM）越少，存活率越高。在这项研究中，我们评估了总 HLA、Ⅰ类和Ⅱ类 MM 的影响是否是受者存活率、闭塞性细支气管炎（BO）的发展和急性排斥反应（AR）的无进展的更重要决定因素。
1994 年 4 月 1 日至 2004 年 6 月 30 日期间，OPTN 数据库中所有成人原发性尸体肺移植受者均纳入研究（n = 9791）。根据 HLA、Ⅰ类和Ⅱ类 MM 的总数创建组。比较受者存活率、AR 无进展和 BO 无进展。使用 Kaplan-Meier 方法计算单变量数据，并通过对数秩检验进行比较。使用 Cox 比例风险方法进行多变量分析。
单变量分析显示，总 HLA（p < 0.001）和Ⅰ类 MM（p = 0.005）较少的受者存活率显著提高。总 HLA Ⅰ类 MM 较少的患者 BO 发生率显著降低（p = 0.036）。AR 仅受Ⅱ类 MM 影响（p = 0.005）。多变量分析显示，总 HLA、Ⅰ类和Ⅱ类 MM 影响受者存活率。总 HLA 和Ⅰ类 MM 与 BO 的发展相关。Ⅱ类 MM 与 AR 的发展相关。
HLA MM 是肺移植受者存活率、BO 和 AR 的重要决定因素。这些数据表明，在分配肺移植器官时，供者与受者的 HLA MM 可能需要考虑。
