PMID- 10808155
OWN - NLM
STAT- MEDLINE
DCOM- 20000623
LR  - 20191210
IS  - 1053-2498 (Print)
IS  - 1053-2498 (Linking)
VI  - 19
IP  - 5
DP  - 2000 May
TI  - Does human leukocyte antigen matching influence the outcome of lung 
      transplantation? An analysis of 3,549 lung transplantations.
PG  - 473-9
AB  - BACKGROUND AND OBJECTIVE: Human leukocyte antigen (HLA) compatibility has been 
      shown to improve the outcome of renal and cardiac transplantation. However, its 
      impact on outcome following lung transplantation is not clear, with several 
      single-center studies reporting inconsistent results. We studied the influence of 
      HLA matching on survival and the development of rejection and obliterative 
      bronchiolitis after lung transplantation, using data from the United Network for 
      Organ Sharing/International Society for Heart and Lung Transplantation registry. 
      METHODS: The study population included adult patients who received cadaveric lung 
      transplants between October 1987 and June 1997 for whom HLA data were available. 
      Two cohorts were examined, depending on the era of transplantation: (1) October 
      1987 to June 1997 (n = 3,549): Differences in actuarial survival as stratified by 
      either the total number of HLA mismatches or the number of mismatches at each HLA 
      locus were determined using a log-rank test. Multivariate logistic regression 
      models were developed to determine independent predictors of survival at 1, 3, 
      and 5 years following lung transplantation. (2) April 1994 to June 1997 (n = 
      1,796): The association of HLA mismatching with acute rejection and obliterative 
      bronchiolitis was determined using a chi-squared analysis. RESULTS: Only 164 
      patients (4.6%) received lung grafts with 2 or fewer HLA mismatches. Univariate 
      analyses demonstrated a significant difference in post-transplant survival by 
      mismatch level, with the total number of HLA mismatches (p = 0.0008) and 
      mismatching at the HLA-A locus (p = 0.002) associated with worse survival. 
      Multivariate logistic regression demonstrated that the number of mismatches at 
      the HLA-A and HLA-DR loci predicted 1-year mortality (incremental odds ratios 
      1.18, p = 0.01, and 1.15, p = 0. 03, respectively). The total number of HLA 
      mismatches predicted 3- and 5-year mortality (incremental odds ratios 1.13 at 3 
      years, p = 0. 0004, and 1.14 at 5 years, p = 0.0002). However, other covariates 
      such as repeat transplantation, transplantation for congenital heart disease, 
      advanced recipient age, and an early era of transplantation were stronger 
      predictors of mortality. We found no significant association between HLA 
      mismatching and the development of obliterative bronchiolitis, although there was 
      an association between mismatching at the HLA-A locus and acute rejection 
      episodes requiring hospital admission (p = 0.008). We also found no association 
      between mismatching at the HLA-B locus and rejection episodes requiring either 
      hospitalization or the alteration of anti-rejection medications (p = 0.034). 
      CONCLUSION: Although the number of HLA mismatches at the HLA-A and HLA-DR loci 
      predicted 1-year mortality and the total number of mismatches predicted 3- and 
      5-year mortality following lung transplantation, the effect of each covariate was 
      small in this multicenter study of 3,549 patients. Further close follow-up of 
      registry patients is necessary to determine the effect of HLA matching on 
      long-term survival and freedom from obliterative bronchiolitis and rejection 
      following lung transplantation. A prospective study of HLA matching for lung 
      transplantation should not yet be considered in view of the small number of 
      grafts with 2 or fewer mismatches and the modest effect of HLA matching on 
      outcome.
FAU - Quantz, M A
AU  - Quantz MA
AD  - London Health Sciences Centre and the University of Western Ontario, London, 
      Canada. maquantz@julian.uwo.ca
FAU - Bennett, L E
AU  - Bennett LE
FAU - Meyer, D M
AU  - Meyer DM
FAU - Novick, R J
AU  - Novick RJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - J Heart Lung Transplant
JT  - The Journal of heart and lung transplantation : the official publication of the 
      International Society for Heart Transplantation
JID - 9102703
RN  - 0 (HLA-A Antigens)
RN  - 0 (HLA-B Antigens)
RN  - 0 (HLA-DR Antigens)
SB  - IM
MH  - Adult
MH  - Graft Survival/immunology
MH  - HLA-A Antigens/*analysis
MH  - HLA-B Antigens/*analysis
MH  - HLA-DR Antigens/*analysis
MH  - *Histocompatibility Testing
MH  - Humans
MH  - Lung Transplantation/*immunology/mortality
MH  - Odds Ratio
MH  - *Outcome Assessment, Health Care
MH  - Prognosis
MH  - Prospective Studies
MH  - Survival Rate
MH  - Tissue Donors
EDAT- 2000/05/16 09:00
MHDA- 2000/07/06 11:00
CRDT- 2000/05/16 09:00
PHST- 2000/05/16 09:00 [pubmed]
PHST- 2000/07/06 11:00 [medline]
PHST- 2000/05/16 09:00 [entrez]
AID - S1053-2498(00)00081-4 [pii]
AID - 10.1016/s1053-2498(00)00081-4 [doi]
PST - ppublish
SO  - J Heart Lung Transplant. 2000 May;19(5):473-9. doi: 
      10.1016/s1053-2498(00)00081-4.