PMID- 35313059
OWN - NLM
STAT- MEDLINE
DCOM- 20220718
LR  - 20230509
IS  - 1527-6473 (Electronic)
IS  - 1527-6465 (Print)
IS  - 1527-6465 (Linking)
VI  - 28
IP  - 8
DP  - 2022 Aug
TI  - Donor-recipient human leukocyte antigen A mismatching is associated with hepatic 
      artery thrombosis, sepsis, graft loss, and reduced survival after liver 
      transplant.
PG  - 1306-1320
LID - 10.1002/lt.26458 [doi]
AB  - Human leukocyte antigen (HLA) matching is not routinely performed for liver 
      transplantation as there is no consistent evidence of benefit; however, the 
      impact of HLA mismatching remains uncertain. We explored the effect of class I 
      and II HLA mismatching on graft failure and mortality. A total of 1042 liver 
      transplants performed at a single center between 1999 and 2016 with available HLA 
      typing data were included. The median follow-up period was 9.38 years 
      (interquartile range 4.9-14) and 350/1042 (33.6%) transplants resulted in graft 
      loss and 280/1042 (26.9%) in death. Graft loss and mortality were not associated 
      with the overall number of mismatches at HLA-A, HLA-B, HLA-C, HLA-DR, and HLA-DQ 
      loci. However, graft failure and mortality were both increased in HLA mismatching 
      on graft failure and mortality the presence of one (p = 0.004 and p = 0.01, 
      respectively) and two (p = 0.01 and p = 0.04, respectively) HLA-A mismatches. 
      Elevated hazard ratios for graft failure and death were observed with HLA-A 
      mismatches in univariate and multivariate Cox proportional hazard models. Excess 
      graft loss with HLA-A mismatch (138/940 [14.7%] mismatched compared with 6/102 
      [5.9%] matched transplants) occurred within the first year following 
      transplantation (odds ratio 2.75; p = 0.02). Strikingly, transplants performed at 
      a single all grafts lost due to hepatic artery thrombosis were in 
      HLA-A-mismatched transplants (31/940 vs. 0/102), as were those lost due to sepsis 
      (35/940 vs. 0/102). In conclusion, HLA-A mismatching was associated with 
      increased graft loss and mortality. The poorer outcome for the HLA-mismatched 
      group was due to hepatic artery thrombosis and sepsis, and these complications 
      occurred exclusively with HLA-A-mismatched transplants. These data suggest that 
      HLA-A mismatching is important for outcomes following liver transplant. 
      Therefore, knowledge of HLA-A matching status may potentially allow for enhanced 
      surveillance, clinical interventions in high-risk transplants or stratified HLA-A 
      matching in high-risk recipients.
CI  - (c) 2022 The Authors. Liver Transplantation published by Wiley Periodicals LLC on 
      behalf of American Association for the Study of Liver Diseases.
FAU - Bricogne, Christopher
AU  - Bricogne C
AD  - Sheila Sherlock Liver UnitRoyal Free London NHS Foundation Trust and Institute 
      for Liver and Digestive HealthUniversity College LondonLondonUK.
FAU - Halliday, Neil
AU  - Halliday N
AUID- ORCID: 0000-0001-8220-9139
AD  - Sheila Sherlock Liver UnitRoyal Free London NHS Foundation Trust and Institute 
      for Liver and Digestive HealthUniversity College LondonLondonUK.
FAU - Fernando, Raymond
AU  - Fernando R
AD  - The Anthony Nolan Research InstituteRoyal Free London NHS Foundation 
      TrustLondonUK.
FAU - Tsochatzis, Emmanuel A
AU  - Tsochatzis EA
AUID- ORCID: 0000-0001-5069-2461
AD  - Sheila Sherlock Liver UnitRoyal Free London NHS Foundation Trust and Institute 
      for Liver and Digestive HealthUniversity College LondonLondonUK.
FAU - Davidson, Brian R
AU  - Davidson BR
AD  - 158987UCL Division of Surgery and Interventional SciencesRoyal Free 
      HospitalLondonUK.
FAU - Harber, Mark
AU  - Harber M
AUID- ORCID: 0000-0002-5441-2452
AD  - 4965Kidney UnitRoyal Free London NHS Foundation TrustLondonUK.
FAU - Westbrook, Rachel H
AU  - Westbrook RH
AD  - Sheila Sherlock Liver UnitRoyal Free London NHS Foundation Trust and Institute 
      for Liver and Digestive HealthUniversity College LondonLondonUK.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220504
PL  - United States
TA  - Liver Transpl
JT  - Liver transplantation : official publication of the American Association for the 
      Study of Liver Diseases and the International Liver Transplantation Society
JID - 100909185
RN  - 0 (HLA Antigens)
RN  - 0 (HLA-A Antigens)
SB  - IM
MH  - *Graft Rejection/etiology
MH  - Graft Survival
MH  - HLA Antigens
MH  - *HLA-A Antigens
MH  - Hepatic Artery/surgery
MH  - Humans
MH  - *Liver Diseases
MH  - *Liver Transplantation/adverse effects
MH  - *Sepsis/etiology
MH  - *Thrombosis/etiology
PMC - PMC9541857
COIS- Nothing to report.
EDAT- 2022/03/22 06:00
MHDA- 2022/07/19 06:00
PMCR- 2022/10/07
CRDT- 2022/03/21 17:20
PHST- 2022/03/09 00:00 [revised]
PHST- 2021/12/09 00:00 [received]
PHST- 2022/03/11 00:00 [accepted]
PHST- 2022/03/22 06:00 [pubmed]
PHST- 2022/07/19 06:00 [medline]
PHST- 2022/03/21 17:20 [entrez]
PHST- 2022/10/07 00:00 [pmc-release]
AID - 01445473-202208000-00009 [pii]
AID - LT26458 [pii]
AID - 10.1002/lt.26458 [doi]
PST - ppublish
SO  - Liver Transpl. 2022 Aug;28(8):1306-1320. doi: 10.1002/lt.26458. Epub 2022 May 4.