PMID- 18752327
OWN - NLM
STAT- MEDLINE
DCOM- 20080923
LR  - 20131121
IS  - 1527-3350 (Electronic)
IS  - 0270-9139 (Linking)
VI  - 48
IP  - 3
DP  - 2008 Sep
TI  - Long-term outcome of human leukocyte antigen mismatching in liver 
      transplantation: results of the National Institute of Diabetes and Digestive and 
      Kidney Diseases Liver Transplantation Database.
PG  - 878-88
LID - 10.1002/hep.22435 [doi]
AB  - A perfect or nearly perfect human leukocyte antigen (HLA) match has been 
      associated with better immediate and long-term survival of diseased donor kidney 
      transplants. However, the effect of HLA matching for hepatic allografts remains 
      poorly defined. Using data from the National Institutes of Diabetes and Digestive 
      and Kidney Diseases Liver Transplantation Database, we investigated the 
      association between HLA mismatches and hepatic allograft survival, disease 
      recurrence, and immunosuppression interactions. A, B, and DR loci were used to 
      calculate total mismatch scores of 0 (no mismatches in any loci) to 6 (mismatches 
      in all loci). Seven hundred ninety-nine adults (male, 55%; female, 45%) underwent 
      883 liver transplants. The 10-year graft survival according to total mismatch 
      score was as follows: 0-2, 60%; 3-4, 54%; and 5-6, 57%. There was a negative 
      effect of mismatching at the A locus on patient survival, with shorter survival 
      for patients with 1 or 2 mismatches compared with 0 mismatches [P = 0.05, hazard 
      ratio (HR) = 1.6]. Patients on tacrolimus with 1 or 2 mismatches at B or DR loci 
      appeared to have increased rates of patient and graft survival compared to 
      patients with 0 mismatches, with the appearance of a protective effect of 
      tacrolimus (HR = 0.67). The effect of HLA mismatching was more pronounced on 
      certain disease recurrences. DR-locus mismatch increased recurrence of autoimmune 
      hepatitis (P = 0.01, HR = 4.2) and primary biliary cirrhosis (P = 0.04, HR = 2). 
      Mismatch in the A locus was associated with more recurrence of hepatitis C virus 
      (P = 0.01, HR = 1.6) and primary sclerosing cholangitis (P = 0.03, HR = 2.9). 
      CONCLUSION: Mismatching at the A locus decreases patient survival in liver 
      transplant recipients, and mismatching at the DR and A loci affects recurrence of 
      autoimmune liver diseases and hepatitis C, respectively.
FAU - Balan, Vijayan
AU  - Balan V
AD  - Department of Transplantation Medicine, Mayo Clinic, Phoenix, AZ, USA.
FAU - Ruppert, Kris
AU  - Ruppert K
FAU - Demetris, A Jake
AU  - Demetris AJ
FAU - Ledneva, Tatiana
AU  - Ledneva T
FAU - Duquesnoy, Rene J
AU  - Duquesnoy RJ
FAU - Detre, Katherine M
AU  - Detre KM
FAU - Wei, Yuling L
AU  - Wei YL
FAU - Rakela, Jorge
AU  - Rakela J
FAU - Schafer, Daniel F
AU  - Schafer DF
FAU - Roberts, John P
AU  - Roberts JP
FAU - Everhart, James E
AU  - Everhart JE
FAU - Wiesner, Russell H
AU  - Wiesner RH
LA  - eng
GR  - DK 55883/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Hepatology
JT  - Hepatology (Baltimore, Md.)
JID - 8302946
RN  - 0 (HLA Antigens)
RN  - 0 (HLA-A Antigens)
RN  - 0 (HLA-DR Antigens)
RN  - 0 (Immunosuppressive Agents)
RN  - 83HN0GTJ6D (Cyclosporine)
RN  - WM0HAQ4WNM (Tacrolimus)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Child
MH  - Child, Preschool
MH  - Cyclosporine/therapeutic use
MH  - *Databases as Topic
MH  - Female
MH  - Follow-Up Studies
MH  - Graft Survival/*immunology
MH  - HLA Antigens/*immunology
MH  - HLA-A Antigens/immunology
MH  - HLA-DR Antigens/immunology
MH  - Hepatitis C/immunology/surgery
MH  - Hepatitis, Autoimmune/immunology/surgery
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Liver Cirrhosis, Biliary/immunology/surgery
MH  - Liver Transplantation/*immunology
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - National Institute of Diabetes and Digestive and Kidney Diseases 
      (U.S.)/statistics & numerical data
MH  - Tacrolimus/therapeutic use
MH  - Treatment Outcome
MH  - United States
EDAT- 2008/08/30 09:00
MHDA- 2008/09/24 09:00
CRDT- 2008/08/30 09:00
PHST- 2008/08/30 09:00 [pubmed]
PHST- 2008/09/24 09:00 [medline]
PHST- 2008/08/30 09:00 [entrez]
AID - 10.1002/hep.22435 [doi]
PST - ppublish
SO  - Hepatology. 2008 Sep;48(3):878-88. doi: 10.1002/hep.22435.