Opelz G, Döhler B
Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany.
Tissue Antigens. 2013 Oct;82(4):235-42. doi: 10.1111/tan.12147.
Inclusion of human leukocyte antigen (HLA) matching in donor kidney allocation schemes has been based solely on its association with graft survival. Other long-term effects associated with HLA incompatibility are largely unexplored. Data from deceased donor kidney transplants reported to the Collaborative Transplant Study have been analyzed to assess the relation between HLA mismatching and clinical events to 3 years post-transplant, and an overview of these analyses is presented. A significant correlation was observed between the number of mismatches and the need for anti-rejection therapy during the first year post-transplant, which was maintained for HLA-DR and HLA-A + B mismatching separately and at years 2 and 3 post-transplant. The number of HLA-DR mismatches and the number of HLA-A + B mismatches as well as rejection treatment showed significant associations with the dose of maintenance steroids. The cumulative incidences of death with a functioning graft from infection or cardiovascular causes, but not from cancer, were also significantly associated with HLA mismatching. The number of HLA-DR mismatches showed a significant association with the incidence of non-Hodgkin lymphoma and hip fractures. These findings show that the adverse consequences of HLA mismatching on kidney transplants extend beyond an effect on graft survival, and include an increased risk of death with a functioning graft, non-Hodgkin lymphoma and hip fracture.
在供肾分配方案中纳入人类白细胞抗原（HLA）配型仅仅是基于其与移植物存活的相关性。与HLA不相容相关的其他长期影响在很大程度上尚未得到探索。我们分析了向协作移植研究报告的 deceased 供肾移植数据，以评估HLA错配与移植后3年临床事件之间的关系，并对这些分析进行概述。观察到移植后第一年错配数量与抗排斥治疗需求之间存在显著相关性，这种相关性在移植后2年和3年分别针对HLA - DR和HLA - A + B错配得以维持。HLA - DR错配数量、HLA - A + B错配数量以及排斥反应治疗与维持性类固醇剂量均显示出显著相关性。有功能移植物因感染或心血管原因而非癌症导致的死亡累积发生率也与HLA错配显著相关。HLA - DR错配数量与非霍奇金淋巴瘤和髋部骨折的发生率显示出显著相关性。这些发现表明，HLA错配对肾移植的不良后果不仅限于对移植物存活的影响，还包括有功能移植物死亡风险增加、非霍奇金淋巴瘤和髋部骨折。
