Opelz G, Wujciak T
Department of Transplantation Immunology, University of Heidelberg, Germany.
N Engl J Med. 1994 Mar 24;330(12):816-9. doi: 10.1056/NEJM199403243301203.
In cardiac transplantation, it is standard practice for donor hearts to be allocated to recipients without consideration of the extent of HLA matching. Because the HLA system is highly polymorphic, the likelihood that donor hearts will be well matched to their recipients by chance alone is extremely small. It has therefore not been possible in the past to analyze adequately the success rate of transplantation with HLA-matched hearts.
We initiated a collaborative study in 1985 to evaluate the influence of HLA compatibility on graft survival in heart transplantation. Data were collected from 104 centers in 24 countries.
Of the 8331 patients, 128 received a graft with no HLA-A, B, or DR mismatches or only one mismatch. This frequency (1.5 percent) corresponds to the rate that would be expected from a random allocation of donor organs. The three-year rate of graft survival correlated strongly with HLA compatibility, decreasing from a mean (+/- SE) of 83 +/- 4 percent for the 128 donor hearts with no mismatches or only one mismatch to 76 +/- 2 percent for the 439 hearts with two mismatches and 71 +/- 1 percent for the 7764 hearts with three to six mismatches (P < 0.001). Multifactorial Cox regression analysis showed that this effect was independent of the age and sex of the donor and recipient, the type of underlying disease, the duration of cold ischemia, and the use of prophylaxis with antilymphocyte antibodies (P = 0.005).
Graft survival in heart transplantation is significantly influenced by the extent of HLA compatibility.
在心脏移植中，供体心脏分配给受体时不考虑HLA匹配程度是标准做法。由于HLA系统具有高度多态性，供体心脏仅凭偶然与受体良好匹配的可能性极小。因此，过去无法充分分析HLA匹配心脏移植的成功率。
我们于1985年启动了一项合作研究，以评估HLA相容性对心脏移植中移植物存活的影响。数据收集自24个国家的104个中心。
在8331例患者中，128例接受了无HLA - A、B或DR错配或仅有一个错配的移植物。这个频率（1.5%）与随机分配供体器官时预期的频率相符。移植物三年存活率与HLA相容性密切相关，从128例无错配或仅有一个错配的供体心脏的平均（±标准误）83±4%，降至439例有两个错配的心脏的76±2%，以及7764例有三至六个错配的心脏的71±1%（P<0.001）。多因素Cox回归分析表明，这种效应独立于供体和受体的年龄及性别、潜在疾病类型、冷缺血时间以及抗淋巴细胞抗体预防用药的使用情况（P = 0.005）。
心脏移植中的移植物存活受到HLA相容性程度的显著影响。
