人类白细胞抗原匹配对肺移植术后长期预后的影响。

Influence of human leukocyte antigen matching on long-term outcome after lung transplantation.

作者信息

Wisser W, Wekerle T, Zlabinger G, Senbaclavaci O, Zuckermann A, Klepetko W, Wolner E

机构信息

Department of Cardiothoracic Surgery, University of Vienna, Austria.

出版信息

J Heart Lung Transplant. 1996 Dec;15(12):1209-16.

PMID:8981206

Abstract

BACKGROUND AND METHODS

The importance of human leukocyte antigen matching for long-term outcome after lung transplantation is uncertain. We therefore analyzed retrospectively 78 consecutive primary, isolated lung transplantations (37 female, 41 male; 40 single, 38 bilateral) performed between October 1989 and October 1995 for which human leukocyte antigen typing of both donor and recipient was available. The follow-up ranged from 1 day to 60.3 months. Graft failure, defined as retransplantation or patient death, served as end point.

RESULTS

Graft survival was significantly better with one mismatch at the B locus than with two mismatches (p = 0.046): 67% versus 51% and 61% versus 25% graft survival at 12 and 36 months, respectively. For the B and DR loci combined, a marked matching effect was also observed (p = 0.21 for zero to two mismatches versus three to four mismatches: 81% versus 62% and 51% versus 29% graft survival at 12 and 36 months, respectively. The sum of mismatches at the A, B, C, and DR loci combined showed a similar effect (p = 0.17 for zero to four mismatches versus five to eight mismatches: 83% versus 62% and 58% versus 29% graft survival at 12 and 36 months, respectively. Although no clear effect could be shown for the isolated DR locus, the outcome for the three patients with zero mismatches was notably good: one patient is alive at 27 months, two died 37 and 48 months after transplantation. The number of acute rejection episodes showed a clear but insignificant correlation to the number of mismatches. A similar trend was observed for the incidence of bronchiolitis obliterans syndrome.

CONCLUSIONS

In summary, a strong influence of human leukocyte antigen matching on the long-term outcome after lung transplantation is suggested by our results. A clear trend toward improved graft survival with better human leukocyte antigen matching was observed, with the most significant effect occurring at the B locus.

摘要

背景与方法

肺移植术后人类白细胞抗原配型对长期预后的重要性尚不确定。因此，我们回顾性分析了1989年10月至1995年10月期间连续进行的78例原发性单肺移植（37例女性，41例男性；40例单侧，38例双侧），供体和受体的人类白细胞抗原分型均可用。随访时间为1天至60.3个月。移植失败定义为再次移植或患者死亡，作为终点。

结果

B位点有一个错配的移植物存活率明显高于有两个错配的情况（p = 0.046）：12个月和36个月时移植物存活率分别为67%对51%和61%对25%。对于B和DR位点联合分析，也观察到明显的配型效应（零至两个错配与三至四个错配相比，p = 0.21：12个月和36个月时移植物存活率分别为81%对62%和51%对29%）。A、B、C和DR位点错配总和也显示出类似效应（零至四个错配与五至八个错配相比，p = 0.17：12个月和36个月时移植物存活率分别为83%对62%和58%对29%）。虽然单独的DR位点未显示出明显效应，但三位错配数为零的患者预后明显良好：一名患者在27个月时存活，两名患者在移植后37个月和48个月死亡。急性排斥反应发作次数与错配数呈明显但不显著的相关性。闭塞性细支气管炎综合征的发生率也观察到类似趋势。