Jarcho J, Naftel D C, Shroyer T W, Kirklin J K, Bourge R C, Barr M L, Pitts D G, Starling R C
Cardiac Transplant Research Database Center, University of Alabama at Birmingham.
J Heart Lung Transplant. 1994 Jul-Aug;13(4):583-95; discussion 595-6.
HLA mismatch has been shown to influence survival after heart transplantation. No large multicenter study has examined the effect of HLA mismatch on cardiac allograft rejection. HLA mismatch and other potential risk factors for rejection were analyzed in data from 27 institutions (1719 patients) participating in the Cardiac Transplant Research Database between January 1, 1990, and June 30, 1992. Complete HLA information on the A, B, and DR loci was available for both donor and recipient in 1190 patients. Of these, 619 (52%) had five or six mismatches; 68 (6%) had zero, one, or two mismatches. The mean number of mismatches was 4.4 and did not differ, regardless of donor-recipient race match (4.3 versus 4.8, p = 0.19). According to multivariate analysis, risk factors for time to first rejection included younger recipient age (p < 0.0001), female gender of both donor and recipient (p < 0.0006), number of HLA mismatches (p = 0.013) and black recipient race (p < 0.004). Patients with zero, one, or two mismatches (n = 67) had a 54% freedom from rejection at 1 year versus 36% for patients with three or more mismatches (n = 1005, p = 0.02). HLA mismatch number did not affect time to first rejection or rejection frequency among black patients. Risk factors (by multivariate analysis) for death or retransplantation because of rejection included female recipient gender (p = 0.008) and black recipient race (p = 0.006). The probability of rejection-related death or retransplantation by 2 years was 0% with zero, one, or two HLA mismatches versus 5% for three to six mismatches (p = 0.14). These findings should stimulate further investigation of methods to clarify the HLA effect in heart transplantation and eventually the use of HLA typing in donor-recipient selection.
已证实人类白细胞抗原（HLA）错配会影响心脏移植后的生存率。尚无大型多中心研究探讨HLA错配对心脏移植排斥反应的影响。对1990年1月1日至1992年6月30日期间参与心脏移植研究数据库的27个机构（1719例患者）的数据进行分析，以研究HLA错配及其他潜在的排斥反应风险因素。1190例患者可获取供体和受体完整的A、B和DR位点HLA信息。其中，619例（52%）有5个或6个错配；68例（6%）有0个、1个或2个错配。错配的平均数为4.4，无论供体-受体种族是否匹配均无差异（4.3对4.8，p = 0.19）。多因素分析显示，首次排斥反应发生时间的风险因素包括受体年龄较小（p < 0.0001）、供体和受体均为女性（p < 0.0006）、HLA错配数（p = 0.013）以及受体为黑人种族（p < 0.004）。有0个、1个或2个错配的患者（n = 67）1年时无排斥反应的比例为54%，而有3个或更多错配的患者（n = 1005）为36%（p = 0.02）。HLA错配数对黑人患者首次排斥反应发生时间或排斥反应频率无影响。因排斥反应导致死亡或再次移植的风险因素（多因素分析）包括受体为女性（p = 0.008）和受体为黑人种族（p = 0.006）。有0个、1个或2个HLA错配的患者2年时因排斥反应导致死亡或再次移植的概率为0%，而有3至6个错配的患者为5%（p = 0.14）。这些发现应促使进一步研究明确HLA在心脏移植中作用的方法，并最终在供体-受体选择中应用HLA分型。
