U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology. Regional Reference Laboratory of Transplant Immunology (LIT). Department of Internal Medicine and Specialistics, University of Campania "L. Vanvitelli", Naples, Italy.
U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology. Regional Reference Laboratory of Transplant Immunology (LIT). Department of Internal Medicine and Specialistics, University of Campania "L. Vanvitelli", Naples, Italy.
Transpl Immunol. 2024 Apr;83:102011. doi: 10.1016/j.trim.2024.102011. Epub 2024 Feb 23.
Although there are different data supporting benefits of HLA matching in kidney transplantation, its role in heart transplantation is still unclear. HLA mismatch (MM) between donor and recipient can lead to the development of donor-specific antibodies (DSA) which produces negative events on the outcome of heart transplantation. Moreover, DSAs are involved in the development of antibody-mediated rejection (AMR) and are associated with an increase in cardiac allograft vasculopathy (CAV). In this study it is analyzed retrospectively the influence of HLA matching and anti-HLA antibodies on overall survival, AMR and CAV in heart transplantation. For this retrospective study are recruited heart transplanted patients at the Cardiac Transplantation Centre of Naples between 2000 and 2019. Among the 155 heart transplant patients, the mean number of HLA-A, B, -DR MM (0 to 6) between donor and recipient was 4.5 ± 1.1. The results show a negative association between MM HLA-DR and survival (p = 0.01). Comparison of patients with 0-1 MM at each locus to all others with 2 MM, for both HLA class I and class II, has not showed significant differences in the development of CAV. Our analysis detected DSA in 38.1% of patients. The production of de novo DSA reveals that there is not an influence on survival (p = 0.72) and/or AMR (p = 0.39). Instead, there is an association between the production of DSA class II and the probability of CAV development (p = 0.03). Mean fluorescence intensity (MFI) values were significantly higher in CAV-positive patients that CAV-negative patients (p = 0.02). Prospective studies are needed to evaluate HLA class II matching as an additional parameter for heart allocation, especially considering the increment of waiting list time.
虽然有不同的数据支持 HLA 配型在肾移植中的益处，但它在心脏移植中的作用仍不清楚。供体和受者之间的 HLA 错配 (MM) 可导致供体特异性抗体 (DSA) 的产生，从而对心脏移植的结果产生负面影响。此外，DSA 参与了抗体介导的排斥反应 (AMR) 的发生，并与心脏移植物血管病 (CAV) 的增加有关。在这项研究中，回顾性分析了 HLA 配型和抗 HLA 抗体对心脏移植患者总体生存率、AMR 和 CAV 的影响。为了进行这项回顾性研究，我们招募了 2000 年至 2019 年期间在那不勒斯心脏移植中心接受心脏移植的患者。在 155 例心脏移植患者中，供体和受体之间 HLA-A、B、-DR MM（0 到 6）的平均值为 4.5 ± 1.1。结果表明 HLA-DR MM 与生存率呈负相关（p = 0.01）。比较每个位点 HLA Ⅰ类和Ⅱ类 MM 为 0-1 的患者与 MM 为 2 的所有其他患者，在 CAV 的发展方面没有显示出显著差异。我们的分析在 38.1%的患者中检测到 DSA。新产生的 DSA 表明其对生存率（p = 0.72）和/或 AMR（p = 0.39）没有影响。相反，DSA Ⅱ类的产生与 CAV 发展的概率之间存在关联（p = 0.03）。CAV 阳性患者的平均荧光强度（MFI）值明显高于 CAV 阴性患者（p = 0.02）。需要进行前瞻性研究来评估 HLA Ⅱ类配型作为心脏分配的附加参数，特别是考虑到等待名单时间的增加。
