Division of Pulmonary and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
J Heart Lung Transplant. 2020 Dec;39(12):1455-1462. doi: 10.1016/j.healun.2020.09.016. Epub 2020 Sep 30.
Donor‒recipient HLA-DR locus matching may be protective against bronchiolitis obliterans syndrome (BOS) in lung transplant recipients. It is unknown whether this benefit is more significant among sensitized (calculated panel reactive antibodies (CPRAs) of >0%) and highly sensitized (CPRAs of ≥80%) recipients who may be at a higher risk for BOS.
This was a retrospective cohort study of adults in the Scientific Registry of Transplant Recipients who underwent lung transplantation between May 5, 2005 and May 31, 2019. Retransplant-free survival and BOS-free survival were compared among recipients with 0 vs ≥1 DR mismatches, grouped according to sensitization.
Among all 20,355 included recipients, 0 DR mismatch status was associated with improved retransplant-free survival (hazard ratio [HR] = 0.83, 95% CI = 0.74-0.93, p = 0.002) and BOS-free survival (HR = 0.86, 95% CI = 0.77-0.96, p = 0.007). Among sensitized recipients, 0 DR mismatch status was also associated with improved retransplant-free survival (HR = 0.79, 95% CI = 0.65-0.97, p = 0.02) and BOS-free survival (HR = 0.82, 95% CI = 0.67-1.00, p = 0.04). There was however no difference in retransplant-free or BOS-free survival between sensitized and non-sensitized recipients with 0 DR mismatches. Among highly sensitized recipients, 0 DR mismatch status was not associated with retransplant-free or BOS-free survival. Among sensitized and highly sensitized recipients, 0 DR mismatch status was not associated with reduced use of plasmapheresis or reduced biopsy-proven, treated acute cellular rejection compared with non-sensitized recipients.
HLA-DR matching is associated with a similar improvement in retransplant-free and BOS-free survival among non-sensitized and sensitized lung transplant recipients. DR matching does not confer a more substantial retransplant-free or BOS-free survival benefit to highly sensitized recipients than to non-sensitized recipients.
供受者 HLA-DR 等位基因匹配可能对肺移植受者的细支气管炎闭塞性综合征（BOS）具有保护作用。在计算的群体反应抗体（CPRA）>0%（致敏）和高致敏（CPRA≥80%）的受者中，这种益处是否更显著，这些受者可能面临更高的 BOS 风险，目前尚不清楚。
这是一项在 Scientific Registry of Transplant Recipients 中进行的回顾性队列研究，纳入了 2005 年 5 月 5 日至 2019 年 5 月 31 日期间接受肺移植的成人患者。比较 0 与≥1 个 DR 错配受者的无复发性移植生存和无 BOS 生存，根据致敏情况进行分组。
在所有 20355 例纳入的受者中，0 个 DR 错配状态与改善的无复发性移植生存（风险比[HR] 0.83，95%置信区间[CI] 0.74-0.93，p=0.002）和无 BOS 生存（HR 0.86，95%CI 0.77-0.96，p=0.007）相关。在致敏受者中，0 个 DR 错配状态也与改善的无复发性移植生存（HR 0.79，95%CI 0.65-0.97，p=0.02）和无 BOS 生存（HR 0.82，95%CI 0.67-1.00，p=0.04）相关。然而，0 个 DR 错配受者在致敏和非致敏受者之间，在无复发性移植或无 BOS 生存方面没有差异。在高致敏受者中，0 个 DR 错配状态与无复发性移植或无 BOS 生存无关。在致敏和高致敏受者中，与非致敏受者相比，0 个 DR 错配状态并未降低血浆置换的使用或经活检证实的治疗性急性细胞排斥反应的发生率。
HLA-DR 匹配与非致敏和致敏肺移植受者的无复发性移植和无 BOS 生存的改善相关。DR 匹配并未为高致敏受者带来比非致敏受者更显著的无复发性移植或无 BOS 生存获益。
