Williams Robert C, Opelz Gerhard, McGarvey Chelsea J, Weil E Jennifer, Chakkera Harini A
1 Phoenix Epidemiology and Clinical Research Branch, NIH, NIDDK, Phoenix, AZ. 2 Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany. 3 Mayo Clinic Hospital, Mayo Clinic, Phoenix, AZ. 4 Division of Nephrology, Mayo Clinic, Phoenix, AZ.
Transplantation. 2016 May;100(5):1094-102. doi: 10.1097/TP.0000000000001115.
Since the beginning of the technology, there has been active debate about the role of human leucocyte antigen (HLA) matching in kidney allograft survival. Recent studies have reported diminishing importance of HLA matching, which have, in turn, been challenged by reports that suggest the continuing importance of these loci. Given the controversies, we examined the effect of HLA compatibility on kidney allograft survival by studying all first adult kidney transplants in the United States from a deceased donor.
Using the United Network for Organ Sharing data, we identified first deceased donor kidney transplants between October 1, 1987, and December 31, 2013. Recipients were classified by their number of HLA mismatches. Cox multivariate regression analyses adjusting for recipient and donor transplant characteristics were performed to determine the impact of HLA compatibility on kidney allograft survival.
Study cohort included 189 141 first adult kidney alone transplants, with a total of 994 558 years of kidney allograft follow-up time. Analyses adjusted for recipient and donor characteristics demonstrated a 13% higher risk (hazard ratio, 1.13; 95% confidence interval, 1.06-1.21) with 1 mismatch and a 64% higher risk (hazard ratio, 1.64, 95% confidence interval, 1.56-1.73) with 6 mismatches. Dividing the mismatch categories into 27 ordered permutations, and testing their 57 within mismatch category differences, demonstrated that all but 1 were equal, independent of locus.
A significant linear relationship of hazard ratios was associated with HLA mismatch and affects allograft survival even during the recent periods of increasing success in renal transplantation.
自该技术问世以来，关于人类白细胞抗原（HLA）配型在肾移植存活中的作用一直存在激烈争论。近期研究报告称HLA配型的重要性在降低，而另一些报告则对这些位点的持续重要性提出质疑，这反过来又对上述研究提出了挑战。鉴于存在这些争议，我们通过研究美国所有来自已故供体的首次成人肾移植，来探讨HLA相容性对肾移植存活的影响。
利用器官共享联合网络的数据，我们确定了1987年10月1日至2013年12月31日期间首次接受已故供体肾移植的患者。根据其HLA错配数对受者进行分类。进行Cox多变量回归分析，并对受者和供者的移植特征进行校正，以确定HLA相容性对肾移植存活的影响。
研究队列包括189141例首次单独进行的成人肾移植，肾移植随访总时间达994558人年。对受者和供者特征进行校正后的分析表明，1个错配时风险高13%（风险比，1.13；95%置信区间，1.06 - 1.21），6个错配时风险高64%（风险比，1.64；95%置信区间，1.56 - 1.73）。将错配类别分为27种有序排列，并测试其在错配类别内的57个差异，结果表明除1个差异外，其他所有差异均相等，且与位点无关。
风险比与HLA错配之间存在显著的线性关系，即使在肾移植成功率不断提高的近期，这种关系也会影响移植存活。
