Kok Gautam, Ilcken Eveline F, Houwen Roderick H J, Lindemans Caroline A, Nieuwenhuis Edward E S, Spierings Eric, Fuchs Sabine A
From the Department of Metabolic Diseases, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Ann Surg Open. 2023 Sep 15;4(3):e334. doi: 10.1097/AS9.0000000000000334. eCollection 2023 Sep.
We aim to investigate the effects of genetically based HLA matching on patient and graft survival, and acute and chronic rejection after liver transplantation.
Liver transplantation is a common treatment for patients with end-stage liver disease. In contrast to most other solid organ transplantations, there is no conclusive evidence supporting human leukocyte antigen (HLA) matching for liver transplantations. With emerging alternatives such as transplantation of bankable (stem) cells, HLA matching becomes feasible, which may decrease the need for immunosuppressive therapy and improve transplantation outcomes.
We systematically searched the PubMed, Embase, and Cochrane databases and performed a meta-analysis investigating the effect of genetic HLA matching on liver transplantation outcomes (acute/chronic rejection, graft failure, and mortality).
We included 14 studies with 2682 patients. HLA-C mismatching significantly increased the risk of acute rejection (full mismatching: risk ratio = 1.90, 95% confidence interval = 1.08 to 3.33, = 0.03; partial mismatching: risk ratio = 1.33, 95% confidence interval = 1.07 to 1.66, = 0.01). We did not discern any significant effect of HLA mismatching per locus on acute rejection for HLA-A, -B, -DR, and -DQ, nor on chronic rejection, graft failure, or mortality for HLA-DR, and -DQ.
We found evidence that genetic HLA-C matching reduces the risk of acute rejection after liver transplantation while matching for other loci does not reduce the risk of acute rejection, chronic rejection, graft failure, or mortality.
我们旨在研究基于基因的人类白细胞抗原（HLA）配型对肝移植患者及移植物存活以及急慢性排斥反应的影响。
肝移植是终末期肝病患者的常见治疗方法。与大多数其他实体器官移植不同，目前尚无确凿证据支持肝移植进行人类白细胞抗原（HLA）配型。随着诸如可储存（干）细胞移植等替代方法的出现，HLA配型变得可行，这可能会减少免疫抑制治疗的需求并改善移植结局。
我们系统检索了PubMed、Embase和Cochrane数据库，并进行了一项荟萃分析，以研究基因HLA配型对肝移植结局（急/慢性排斥反应、移植物功能衰竭和死亡率）的影响。
我们纳入了14项研究，共2682例患者。HLA - C错配显著增加了急性排斥反应的风险（完全错配：风险比 = 1.90，95%置信区间 = 1.08至3.33，P = 0.03；部分错配：风险比 = 1.33，95%置信区间 = 1.07至1.66，P = 0.01）。我们未发现HLA - A、- B、- DR和 - DQ每个位点的HLA错配对急性排斥反应有任何显著影响，也未发现HLA - DR和 - DQ对慢性排斥反应、移植物功能衰竭或死亡率有显著影响。
我们发现有证据表明，基因HLA - C配型可降低肝移植后急性排斥反应风险，而其他位点的配型并不能降低急性排斥反应、慢性排斥反应、移植物功能衰竭或死亡率的风险。
