Smith J D, Rose M L, Pomerance A, Burke M, Yacoub M H
Department of Cardiothoracic Surgery, Imperial College of Science & Technology (National Heart and Lung Institute and Royal Brompton & National Heart Hospital), Heart Science Centre, Harefield Hospital, Middlesex, UK.
Lancet. 1995 Nov 18;346(8986):1318-22. doi: 10.1016/s0140-6736(95)92341-1.
HLA matching in cardiac transplants is perceived as being logistically difficult. We studied 1135 consecutive primary cardiac allografts between 1980 and 1994 to assess the effect of HLA mismatching on long-term graft survival and cellular rejection episodes within 3 months of transplantation. We found a significant association between HLA-DR mismatching and the number of episodes of rejection (no mismatch 0.80 [SE 0.13], one mismatch 1.22 [0.06], two mismatches 1.42 [0.06], p < 0.05). We found a similar correlation between the total number of biopsy specimens showing evidence of cellular rejection and HLA-DR mismatch. The time between operation and the first rejection episode shortened with increasing HLA-DR mismatch (no mismatch 85.5 [37.3] days, one mismatch 43.1 [8.1], two mismatches 24.1 [2.9], p < 0.05). Furthermore, the proportion of patients with no evidence of rejection correlated with HLA-DR incompatibility. A significant association between improved graft survival and HLA-DR mismatching was found over 1, 5, and 10 years after transplantation (no mismatch 1 year 92%, 5 years 83%, 10 years 76%, one mismatch 1 year 81%, 5 years 73%, 10 years 59%, and two mismatches 78% 1 year, 5 years 70%, and 10 years 52%, p = 0.02). Increased efforts to prospectively HLA match patients has resulted in 25% of patients transplanted between January and May 1995 (n = 13/52) receiving grafts matched for HLA-DR. HLA matching reduces the frequency and severity of acute cardiac allograft rejection and improves graft survival for up to 10 years. Our preliminary results suggest that it is possible to use HLA matching prospectively for our selection of recipients.
心脏移植中的人类白细胞抗原（HLA）配型在后勤保障方面被认为存在困难。我们研究了1980年至1994年间连续进行的1135例初次心脏同种异体移植，以评估HLA错配对移植后3个月内长期移植物存活和细胞排斥反应发作的影响。我们发现HLA - DR错配与排斥反应发作次数之间存在显著关联（无错配0.80 [标准误0.13]，一个错配1.22 [0.06]，两个错配1.42 [0.06]，p < 0.05）。我们发现显示细胞排斥证据的活检标本总数与HLA - DR错配之间存在类似的相关性。随着HLA - DR错配增加，手术至首次排斥反应发作的时间缩短（无错配85.5 [37.3]天，一个错配43.1 [8.1]，两个错配24.1 [2.9]，p < 0.05）。此外，无排斥反应证据的患者比例与HLA - DR不相容性相关。在移植后1年、5年和10年发现移植物存活改善与HLA - DR错配之间存在显著关联（无错配1年92%，5年83%，10年76%；一个错配1年81%，5年73%，10年59%；两个错配1年78%，5年70%，10年52%，p = 0.02）。对患者进行前瞻性HLA配型的努力增加，使得1995年1月至5月间移植的患者中有25%（n = 13/52）接受了HLA - DR配型的移植物。HLA配型可降低急性心脏同种异体移植排斥反应的频率和严重程度，并改善长达10年的移植物存活。我们的初步结果表明，有可能前瞻性地使用HLA配型来选择受者。
