PMID- 9158031
OWN - NLM
STAT- MEDLINE
DCOM- 19970606
LR  - 20190713
IS  - 0041-1337 (Print)
IS  - 0041-1337 (Linking)
VI  - 63
IP  - 9
DP  - 1997 May 15
TI  - Human leukocyte antigen compatibility in heart transplantation: evidence for a 
      differential role of HLA matching on short- and medium-term patient survival.
PG  - 1346-51
AB  - BACKGROUND: Studies of the influence of human leukocyte antigen (HLA) matching on 
      cardiac transplant outcome have proved inconclusive, mainly due to the lack of 
      well-matched grafts. However, a growing number of studies report improved 
      clinical course and patient survival in cases with increased HLA compatibility. 
      Opelz et al. believe these benefits justify the introduction of prospective 
      HLA-matching strategies. METHODS: We performed univariate and multivariate 
      analyses to examine the short- and medium-term influence of HLA matching on 556 
      consecutive primary heart transplants performed at a single center between 1983 
      and 1994. Overall graft survival at 1, 3, and 5 years was 80%, 74%, and 67% 
      respectively. Sixteen (2.9%) grafts failed within 5 days and were not considered 
      in the analysis of the HLA matching and graft survival data. RESULTS: Complete 
      HLA-A, -B, and -DR typing data were available on 477 transplant pairs. The 
      results demonstrate a 12% 1-year survival advantage for 31 patients with zero to 
      two HLA antigen mismatches compared with three to six mismatches. The influence 
      of each individual locus was 6.1%, 8.4%, and 5.4% for zero HLA-A, -B, and -DR 
      mismatches, respectively, compared with two mismatches. However, when outcome 
      from 1 to 5 years was considered, analysis of the role of each locus revealed 
      marked differences. HLAA-matched grafts (n=45) had a 24% lower survival rate 
      compared with two-antigen-mismatched grafts (n=148; 88% [SE 3.1] vs. 64% [SE 
      8.2], respectively; P=0.009). Furthermore, 34% of HLA-A-matched grafts failed 
      between 1 and 5 years, compared with only 5% of HLA-B-matched grafts (P=0.013). 
      CONCLUSIONS: These data suggest that although HLA matching is effective at 
      reducing acute graft loss, in the longer term, HLA-A matching may impair 
      survival. HLA-A may serve as a restriction element for indirect presentation of 
      allopeptides or tissue-specific minor histocompatibility antigens, facilitating 
      chronic graft loss. Therefore, we advocate a differential role for HLA matching 
      over two epochs. A blanket approach to prospective matching for heart transplants 
      may be premature for optimal long-term survival.
FAU - Taylor, C J
AU  - Taylor CJ
AD  - Tissue Typing Laboratory, Addenbrooke's NHS Trust, Cambridge, England.
FAU - Smith, S I
AU  - Smith SI
FAU - Sharples, L D
AU  - Sharples LD
FAU - Parameshwar, J
AU  - Parameshwar J
FAU - Cary, N R
AU  - Cary NR
FAU - Keogan, M
AU  - Keogan M
FAU - Wallwork, J
AU  - Wallwork J
FAU - Large, S R
AU  - Large SR
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
RN  - 0 (HLA Antigens)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Child
MH  - Female
MH  - Graft Rejection/immunology
MH  - Graft Survival/immunology
MH  - HLA Antigens/*immunology
MH  - Heart Transplantation/*immunology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - T-Lymphocytes/immunology
MH  - Time Factors
EDAT- 1997/05/15 00:00
MHDA- 1997/05/15 00:01
CRDT- 1997/05/15 00:00
PHST- 1997/05/15 00:00 [pubmed]
PHST- 1997/05/15 00:01 [medline]
PHST- 1997/05/15 00:00 [entrez]
AID - 10.1097/00007890-199705150-00024 [doi]
PST - ppublish
SO  - Transplantation. 1997 May 15;63(9):1346-51. doi: 
      10.1097/00007890-199705150-00024.