HLA mismatches 影响肺移植受者的存活率、闭塞性细支气管炎和排斥反应：对供肺分配的影响。

HLA mismatches influence lung transplant recipient survival, bronchiolitis obliterans and rejection: implications for donor lung allocation.

机构信息

Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center at Dallas, TX 75390, USA.

出版信息

J Heart Lung Transplant. 2011 Apr;30(4):426-34. doi: 10.1016/j.healun.2010.10.005. Epub 2010 Dec 8.

DOI:10.1016/j.healun.2010.10.005

PMID:21145259

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.

摘要

背景

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。

方法

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。

结果

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。