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

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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
Issue number4
StatePublished - Apr 1 2011



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

ASJC Scopus subject areas

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

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