Hayes Don, Auletta Jeffery J, Whitson Bryan A, Black Sylvester M, Kirkby Stephen, Tobias Joseph D, Mansour Heidi M
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Host Defense Program, Nationwide Children's Hospital, Columbus, Ohio; Section of Hematology/Oncology and Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, Ohio; Section of Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio.
J Thorac Cardiovasc Surg. 2016 Feb;151(2):549-57.e1. doi: 10.1016/j.jtcvs.2015.08.022. Epub 2015 Aug 13.
The influence of human leukocyte antigen (HLA) mismatching on survival in adult and pediatric patients with cystic fibrosis (CF) after lung transplantation (LTx) is unknown.
The United Network for Organ Sharing database was queried from 1987 to 2013 to determine the influence of HLA mismatching on survival in adult and pediatric CF LTx recipients by assessing the association of HLA mismatching with survival in first-time adult (aged ≥ 18 years) and pediatric (aged <18 years) recipients.
Of 3149 adult and 489 pediatric patients with CF, 3145 and 489 were used for univariate Cox analysis, 2687 and 363 for Kaplan-Meier survival analysis, and 2073 and 257 for multivariate Cox analysis, respectively. Univariate analyses in adult and pediatric patients with CF demonstrated conflicting associations between HLA mismatching and survival (adult hazard ratio [HR], 1.0; 95% confidence interval [CI], 0.97-1.1; P = .45 vs pediatric HR, 0.87; 95% CI, 0.77-0.99; P = .032). Multivariate Cox models including both pediatric and adult patients confirmed that HLA mismatching had an initially protective effect at young ages (HR, 0.85; 95% CI, 0.73-0.99; P = .044) and that this protective effect diminished at older ages and was no longer associated with survival at P < .05 beyond age 10 years.
HLA mismatching has significantly different implications for survival after LTx in adult compared with pediatric patients with CF.
人类白细胞抗原（HLA）错配对成年和儿童囊性纤维化（CF）患者肺移植（LTx）后生存的影响尚不清楚。
查询器官共享联合网络数据库1987年至2013年的数据，通过评估HLA错配与首次成年（年龄≥18岁）和儿童（年龄<18岁）受者生存的相关性，来确定HLA错配对成年和儿童CF LTx受者生存的影响。
在3149例成年CF患者和489例儿童CF患者中，分别有3145例和489例用于单因素Cox分析，2687例和363例用于Kaplan-Meier生存分析，2073例和257例用于多因素Cox分析。成年和儿童CF患者的单因素分析显示HLA错配与生存之间的关联相互矛盾（成年风险比[HR]，1.0；95%置信区间[CI]，0.97-1.1；P = 0.45，而儿童HR，0.87；95%CI，0.77-0.99；P = 0.032）。包括儿童和成年患者的多因素Cox模型证实，HLA错配在年轻时最初具有保护作用（HR，0.85；95%CI，0.73-0.99；P = 0.044），且这种保护作用在年龄较大时减弱，在10岁以后P < 0.05时与生存不再相关。
与儿童CF患者相比，HLA错配对成年CF患者LTx后的生存具有显著不同的影响。
