HUMAN LEUKOCYTE ANTIGEN COMPATIBILITY IN HEART TRANSPLANTATION
| Autor: | Nat R.B. Cary, Linda D. Sharples, Jayan Parameshwar, Sheila I. Smith, John Wallwork, Stephen R. Large, Mary Keogan, Craig J. Taylor |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Adult
Graft Rejection Male Time Factors Adolescent T-Lymphocytes medicine.medical_treatment Human leukocyte antigen Medium term HLA-C HLA Antigens Humans Medicine Child Aged Heart transplantation Transplantation business.industry Graft Survival Patient survival Middle Aged Histocompatibility Clinical trial Immunology Heart Transplantation Female business |
| Zdroj: | Transplantation. 63:1346-1351 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/00007890-199705150-00024 |
| Popis: | Studies of the influence of human leukocyte antigen (HLA) matching on cardiac transplant outcome have proved inconclusive, mainly due to the lack of well-matched grafts. However, a growing number of studies report improved clinical course and patient survival in cases with increased HLA compatibility. Opelz et al. believe these benefits justify the introduction of prospective HLA-matching strategies.We performed univariate and multivariate analyses to examine the short- and medium-term influence of HLA matching on 556 consecutive primary heart transplants performed at a single center between 1983 and 1994. Overall graft survival at 1, 3, and 5 years was 80%, 74%, and 67% respectively. Sixteen (2.9%) grafts failed within 5 days and were not considered in the analysis of the HLA matching and graft survival data.Complete HLA-A, -B, and -DR typing data were available on 477 transplant pairs. The results demonstrate a 12% 1-year survival advantage for 31 patients with zero to two HLA antigen mismatches compared with three to six mismatches. The influence of each individual locus was 6.1%, 8.4%, and 5.4% for zero HLA-A, -B, and -DR mismatches, respectively, compared with two mismatches. However, when outcome from 1 to 5 years was considered, analysis of the role of each locus revealed marked differences. HLAA-matched grafts (n=45) had a 24% lower survival rate compared with two-antigen-mismatched grafts (n=148; 88% [SE 3.1] vs. 64% [SE 8.2], respectively; P=0.009). Furthermore, 34% of HLA-A-matched grafts failed between 1 and 5 years, compared with only 5% of HLA-B-matched grafts (P=0.013).These data suggest that although HLA matching is effective at reducing acute graft loss, in the longer term, HLA-A matching may impair survival. HLA-A may serve as a restriction element for indirect presentation of allopeptides or tissue-specific minor histocompatibility antigens, facilitating chronic graft loss. Therefore, we advocate a differential role for HLA matching over two epochs. A blanket approach to prospective matching for heart transplants may be premature for optimal long-term survival. |
| Databáze: | OpenAIRE |
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