PMID- 12438966
OWN - NLM
STAT- MEDLINE
DCOM- 20021209
LR  - 20190713
IS  - 0041-1337 (Print)
IS  - 0041-1337 (Linking)
VI  - 74
IP  - 8
DP  - 2002 Oct 27
TI  - Role of HLA compatibility in pediatric living-related liver transplantation.
PG  - 1175-80
AB  - BACKGROUND: Human leukocyte antigen (HLA) matching is, at present, not used for 
      the allocation of cadaveric hepatic allografts because the liver is generally 
      believed to be less susceptible to HLA-mediated rejection. However, the exact 
      role of HLA compatibility in the long-term outcome of liver transplantation is 
      not yet clearly defined. One of the advantages of living-related liver 
      transplantation (LRLT) could be a better histocompatibility between donor and 
      recipient. This study aimed at an assessment of the influence of HLA 
      compatibility in a large series of LRLTs. METHODS: A total of 321 pediatric 
      patients who underwent ABO-identical or ABO-compatible primary LRLT from the 
      parental donors in the period between June 1990 and August 2000 were involved in 
      the study. Graft survival, rejection episodes, and immunosuppression were 
      evaluated from the viewpoint of HLA compatibility. RESULTS: The overall 1- and 
      5-year graft survivals were 85.7% and 84.1%, respectively. The cumulative 5-year 
      graft survivals in HLA 0-, 1-, 2- and 3-mismatch groups (A, B, and DR) were 100% 
      (n=10), 78.9% (n=19), 86.2% (n=87), and 82.9% (n=205), respectively (P=0.525). 
      The overall incidence of rejection during the follow-up period (median 66 months, 
      range 16-139 months) was 46.1%. No significant difference was found in the 
      incidence of rejection and rejection-free survival among the four groups. 
      However, steroid-resistant rejection that necessitated OKT3 treatment (n=6) and 
      chronic rejection (n=2) were recognized only in the 3-mismatch group. The 
      whole-blood trough level of tacrolimus and the duration of steroid administration 
      were not significantly different among the groups. The rate of the patients who 
      succeeded in withdrawal from immunosuppression was also similar among the groups. 
      However, the trough level of tacrolimus needed for maintenance of an acceptable 
      liver function test during the chronic phase tended to be lower in well-matched 
      pairs, and a high percentage of immunosuppressant-free patients were found in the 
      0-mismatch group. Fatal graft-versus-host disease developed in one patient with a 
      complete one-way HLA-matched transplant. CONCLUSION: We could not find any 
      supportive evidence of beneficial effects of HLA-matching in pediatric LRLT. The 
      potential benefit of HLA-matching for the reduction protocol for 
      immunosuppressants may play a role in the withdrawal program. It appears 
      unnecessary to pay attention to HLA compatibility in donor selection in LRLT, 
      except for one-way HLA matching, or to adjust immunosuppression according to HLA 
      compatibility.
FAU - Kasahara, Mureo
AU  - Kasahara M
AD  - Organ Transplant Unit, Department of Transplant Surgery, Kyoto University 
      Hospital, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. mureo@kuhp. 
      kyoto-u.ac.jp
FAU - Kiuchi, Tetsuya
AU  - Kiuchi T
FAU - Uryuhara, Kenji
AU  - Uryuhara K
FAU - Uemoto, Shinji
AU  - Uemoto S
FAU - Fujimoto, Yasuhiro
AU  - Fujimoto Y
FAU - Ogura, Yasuhiro
AU  - Ogura Y
FAU - Oike, Fumitaka
AU  - Oike F
FAU - Kaihara, Satoshi
AU  - Kaihara S
FAU - Egawa, Hiroto
AU  - Egawa H
FAU - Tanaka, Koichi
AU  - Tanaka K
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (HLA Antigens)
RN  - 0 (Immunosuppressive Agents)
RN  - WM0HAQ4WNM (Tacrolimus)
SB  - IM
MH  - Acute Disease
MH  - Adolescent
MH  - Adult
MH  - Disease-Free Survival
MH  - Female
MH  - Follow-Up Studies
MH  - Graft Rejection/epidemiology/*immunology
MH  - Graft Survival/*immunology
MH  - HLA Antigens/*analysis
MH  - Histocompatibility Testing
MH  - Humans
MH  - Immunosuppressive Agents/administration & dosage
MH  - Incidence
MH  - Liver Transplantation/*immunology
MH  - *Living Donors
MH  - Male
MH  - Middle Aged
MH  - Tacrolimus/administration & dosage
EDAT- 2002/11/20 04:00
MHDA- 2002/12/10 04:00
CRDT- 2002/11/20 04:00
PHST- 2002/11/20 04:00 [pubmed]
PHST- 2002/12/10 04:00 [medline]
PHST- 2002/11/20 04:00 [entrez]
AID - 10.1097/00007890-200210270-00020 [doi]
PST - ppublish
SO  - Transplantation. 2002 Oct 27;74(8):1175-80. doi: 
      10.1097/00007890-200210270-00020.