HLA mismatches influence lung transplant recipient survival, bronchiolitis obliterans and rejection: Implications for donor lung allocation

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Abstract

Background: Human leukocyte antigen (HLA) histocompatibility is not considered when placing donor allografts for lung transplantation. We previously reported that fewer individual Class I (HLA-A and -B) and Class II (HLA-DR) antigen mismatches (MM) correlated with improved survival in lung transplant recipients. In this study we evaluated whether the effects of total HLA, Class I and Class II MM were more important determinants of: (1) recipient survival; (2) development of bronchiolitis obliterans (BO); and (3) freedom from acute rejection (AR). Methods: All adult primary cadaveric lung recipients transplanted between April 1, 1994, and June 30, 2004 entered in the OPTN database were included (n = 9,791). Groups were created based on the total number of HLA, Class I and Class II MM. Recipient survival, freedom from AR and freedom from BO were compared. Univariate data were computed using the Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using the Cox proportional hazards method. Results: Univariate analysis identified significantly improved survival in recipients with fewer total HLA (p < 0.001) and Class I MM (p = 0.005). The incidence of BO was significantly lower in patients with fewer total Class I MM (p = 0.036). AR was influenced only by Class II MM (p = 0.005). By multivariate analysis, total HLA, Class I and Class II MM impacted recipient survival. Total HLA and Class I MM correlated with development of BO. Class II MM correlated with development of AR. Conclusion: HLA MM are important determinants of lung transplant survival, BO and AR. These data suggest that donorrecipient HLA MM may warrant consideration when allocating organs for lung transplantation.

Original languageEnglish (US)
Pages (from-to)426-434
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume30
Issue number4
DOIs
StatePublished - Apr 2011

Fingerprint

Bronchiolitis Obliterans
HLA Antigens
Tissue Donors
Lung
Survival
Lung Transplantation
Multivariate Analysis
Transplant Recipients
HLA-D Antigens
Histocompatibility
Organ Transplantation
Allografts
Databases

Keywords

  • acute rejection
  • bronchiolitis obliterans
  • HLA antigen
  • lung transplantation
  • survival

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

@article{1c964f2688014ac98546c87b7751651d,
title = "HLA mismatches influence lung transplant recipient survival, bronchiolitis obliterans and rejection: Implications for donor lung allocation",
abstract = "Background: Human leukocyte antigen (HLA) histocompatibility is not considered when placing donor allografts for lung transplantation. We previously reported that fewer individual Class I (HLA-A and -B) and Class II (HLA-DR) antigen mismatches (MM) correlated with improved survival in lung transplant recipients. In this study we evaluated whether the effects of total HLA, Class I and Class II MM were more important determinants of: (1) recipient survival; (2) development of bronchiolitis obliterans (BO); and (3) freedom from acute rejection (AR). Methods: All adult primary cadaveric lung recipients transplanted between April 1, 1994, and June 30, 2004 entered in the OPTN database were included (n = 9,791). Groups were created based on the total number of HLA, Class I and Class II MM. Recipient survival, freedom from AR and freedom from BO were compared. Univariate data were computed using the Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using the Cox proportional hazards method. Results: Univariate analysis identified significantly improved survival in recipients with fewer total HLA (p < 0.001) and Class I MM (p = 0.005). The incidence of BO was significantly lower in patients with fewer total Class I MM (p = 0.036). AR was influenced only by Class II MM (p = 0.005). By multivariate analysis, total HLA, Class I and Class II MM impacted recipient survival. Total HLA and Class I MM correlated with development of BO. Class II MM correlated with development of AR. Conclusion: HLA MM are important determinants of lung transplant survival, BO and AR. These data suggest that donorrecipient HLA MM may warrant consideration when allocating organs for lung transplantation.",
keywords = "acute rejection, bronchiolitis obliterans, HLA antigen, lung transplantation, survival",
author = "Matthias Peltz and Edwards, {Leah B.} and Jessen, {Michael E} and Fernando Torres and Meyer, {Dan M}",
year = "2011",
month = "4",
doi = "10.1016/j.healun.2010.10.005",
language = "English (US)",
volume = "30",
pages = "426--434",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",
number = "4",

}

TY - JOUR

T1 - HLA mismatches influence lung transplant recipient survival, bronchiolitis obliterans and rejection

T2 - Implications for donor lung allocation

AU - Peltz, Matthias

AU - Edwards, Leah B.

AU - Jessen, Michael E

AU - Torres, Fernando

AU - Meyer, Dan M

PY - 2011/4

Y1 - 2011/4

N2 - Background: Human leukocyte antigen (HLA) histocompatibility is not considered when placing donor allografts for lung transplantation. We previously reported that fewer individual Class I (HLA-A and -B) and Class II (HLA-DR) antigen mismatches (MM) correlated with improved survival in lung transplant recipients. In this study we evaluated whether the effects of total HLA, Class I and Class II MM were more important determinants of: (1) recipient survival; (2) development of bronchiolitis obliterans (BO); and (3) freedom from acute rejection (AR). Methods: All adult primary cadaveric lung recipients transplanted between April 1, 1994, and June 30, 2004 entered in the OPTN database were included (n = 9,791). Groups were created based on the total number of HLA, Class I and Class II MM. Recipient survival, freedom from AR and freedom from BO were compared. Univariate data were computed using the Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using the Cox proportional hazards method. Results: Univariate analysis identified significantly improved survival in recipients with fewer total HLA (p < 0.001) and Class I MM (p = 0.005). The incidence of BO was significantly lower in patients with fewer total Class I MM (p = 0.036). AR was influenced only by Class II MM (p = 0.005). By multivariate analysis, total HLA, Class I and Class II MM impacted recipient survival. Total HLA and Class I MM correlated with development of BO. Class II MM correlated with development of AR. Conclusion: HLA MM are important determinants of lung transplant survival, BO and AR. These data suggest that donorrecipient HLA MM may warrant consideration when allocating organs for lung transplantation.

AB - Background: Human leukocyte antigen (HLA) histocompatibility is not considered when placing donor allografts for lung transplantation. We previously reported that fewer individual Class I (HLA-A and -B) and Class II (HLA-DR) antigen mismatches (MM) correlated with improved survival in lung transplant recipients. In this study we evaluated whether the effects of total HLA, Class I and Class II MM were more important determinants of: (1) recipient survival; (2) development of bronchiolitis obliterans (BO); and (3) freedom from acute rejection (AR). Methods: All adult primary cadaveric lung recipients transplanted between April 1, 1994, and June 30, 2004 entered in the OPTN database were included (n = 9,791). Groups were created based on the total number of HLA, Class I and Class II MM. Recipient survival, freedom from AR and freedom from BO were compared. Univariate data were computed using the Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using the Cox proportional hazards method. Results: Univariate analysis identified significantly improved survival in recipients with fewer total HLA (p < 0.001) and Class I MM (p = 0.005). The incidence of BO was significantly lower in patients with fewer total Class I MM (p = 0.036). AR was influenced only by Class II MM (p = 0.005). By multivariate analysis, total HLA, Class I and Class II MM impacted recipient survival. Total HLA and Class I MM correlated with development of BO. Class II MM correlated with development of AR. Conclusion: HLA MM are important determinants of lung transplant survival, BO and AR. These data suggest that donorrecipient HLA MM may warrant consideration when allocating organs for lung transplantation.

KW - acute rejection

KW - bronchiolitis obliterans

KW - HLA antigen

KW - lung transplantation

KW - survival

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U2 - 10.1016/j.healun.2010.10.005

DO - 10.1016/j.healun.2010.10.005

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VL - 30

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JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

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