PMID- 31339067
OWN - NLM
STAT- MEDLINE
DCOM- 20210104
LR  - 20210110
IS  - 2047-9980 (Electronic)
IS  - 2047-9980 (Linking)
VI  - 8
IP  - 15
DP  - 2019 Aug 6
TI  - Human Leukocyte Antigen-Based Risk Stratification in Heart Transplant 
      Recipients-Implications for Targeted Surveillance.
PG  - e011124
LID - 10.1161/JAHA.118.011124 [doi]
LID - e011124
AB  - Background Human leukocyte antigen (HLA) matching isn't routinely performed in 
      heart transplantation. Novel allograft perfusion methods may make HLA matching 
      feasible. The purpose of this study is to reexamine whether HLA mismatch may be 
      used in risk stratification to improve outcomes in heart transplantation. Methods 
      and Results We analyzed 34 681 recipients undergoing heart transplantation 
      between 1987 and 2013. We used HLAMatchmaker to quantify HLA eplet mismatches and 
      Cox regression for analysis of time to graft loss. Recipients with 4 mismatched 
      HLA-DR/DQ alleles and >40 eplets reached an adjusted hazard ratio (HR) for graft 
      loss of 1.17 (95% CI 1.07-1.28) and 1.11 (95% CI 1.03-1.21), respectively. We 
      found significant interaction between recipient age and numbers of HLA-DR/DQ 
      allele and eplet mismatches resulting in an adjusted HR of 1.78 (95% 1.13-2.80) 
      and 1.82 (95% CI, 1.23-2.70), respectively. HR for both interaction terms was 
      0.99 (95% CI, 0.98-1.00). Risk of graft loss was more pronounced after 1 year, 
      where recipient <40 years with 4 mismatched HLA-DR/DQ alleles and >40 eplets had 
      an adjusted HR of 1.51 (95% CI 1.12-2.03) and 1.32 (95% CI 1.02-1.70), 
      respectively. Pre-sensitized recipients with panel reactive antibodies >10% had 
      an adjusted HR=1.27 (95% CI 1.16-1.40) for graft loss within 1 year but not 
      thereafter. HLA eplet mismatch was independent of panel reactive antibodies on 
      reduction of graft loss within and after 1 year, P (interaction)=0.888 and 0.389. 
      Conclusions HLA mismatch may be used in risk stratification for intensified 
      post-transplant surveillance and therapy.
FAU - Nilsson, Johan
AU  - Nilsson J
AD  - Department of Clinical Sciences Lund Cardiothoracic Surgery Lund University and 
      Skane University Hospital Lund Sweden.
FAU - Ansari, David
AU  - Ansari D
AD  - Department of Clinical Sciences Lund Cardiothoracic Surgery Lund University and 
      Skane University Hospital Lund Sweden.
FAU - Ohlsson, Mattias
AU  - Ohlsson M
AD  - Department of Astronomy and Theoretical Physics Computational Biology and 
      Biological Physics Lund University Lund Sweden.
FAU - Hoglund, Peter
AU  - Hoglund P
AD  - Department of Laboratory Medicine, Clinical Chemistry and Pharmacology Lund 
      University and Office for Medical Services Lund Sweden.
FAU - Liedberg, Ann-Sofie
AU  - Liedberg AS
AD  - Department of Laboratory Medicine Clinical Immunology and Transfusion Medicine 
      Lund University and Office for Medical Services Lund Sweden.
FAU - Smith, J Gustav
AU  - Smith JG
AD  - Department of Clinical Sciences Lund Cardiology Lund University and Skane 
      University Hospital Wallenberg Center for Molecular Medicine and Lund University 
      Diabetes Center Lund University Lund Sweden.
FAU - Nugues, Pierre
AU  - Nugues P
AD  - Department of Computer Science Lund University Lund Sweden.
FAU - Andersson, Bodil
AU  - Andersson B
AD  - Department of Clinical Sciences Lund Surgery Lund University and Skane University 
      Hospital Lund Sweden.
LA  - eng
GR  - ERC_/European Research Council/International
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190724
PL  - England
TA  - J Am Heart Assoc
JT  - Journal of the American Heart Association
JID - 101580524
RN  - 0 (HLA Antigens)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Female
MH  - *HLA Antigens
MH  - *Heart Transplantation
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Patient Selection
MH  - *Population Surveillance
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
MH  - *Transplantation Immunology
PMC - PMC6761633
OTO - NOTNLM
OT  - HLAMatchmaker
OT  - human leukocyte antigen
OT  - rejection
OT  - risk stratification
OT  - survival
OT  - transplantation
EDAT- 2019/07/25 06:00
MHDA- 2021/01/05 06:00
PMCR- 2019/08/06
CRDT- 2019/07/25 06:00
PHST- 2019/07/25 06:00 [entrez]
PHST- 2019/07/25 06:00 [pubmed]
PHST- 2021/01/05 06:00 [medline]
PHST- 2019/08/06 00:00 [pmc-release]
AID - JAH34278 [pii]
AID - 10.1161/JAHA.118.011124 [doi]
PST - ppublish
SO  - J Am Heart Assoc. 2019 Aug 6;8(15):e011124. doi: 10.1161/JAHA.118.011124. Epub 
      2019 Jul 24.