PMID- 9930450
OWN - NLM
STAT- MEDLINE
DCOM- 19990218
LR  - 20190628
IS  - 0003-4975 (Print)
IS  - 0003-4975 (Linking)
VI  - 66
IP  - 6 Suppl
DP  - 1998 Dec
TI  - Effect of HLA mismatching and antibody status on "homovital" aortic valve 
      homograft performance.
PG  - S212-5
AB  - BACKGROUND: Recipients of "homovital" aortic valve homografts are known to 
      produce specific antibodies to human leukocyte antigen (HLA) determinants present 
      on the cellular compartment of the valve tissue; however, the clinical 
      significance of these antibodies is unknown. Data from 182 patients receiving 
      homovital aortic valve homografts has been analyzed to determine the impact of 
      HLA disparity and HLA antibody production on survival and function of the 
      homograft. METHODS: Human leukocyte antigen mismatch data were available for 127 
      patients (mean follow-up, 6.02+/-0.26 years). Two patients were considered well 
      matched for HLA A+B antigens (zero or one mismatch) compared with 125 poorly 
      matched (two to four mismatches). Nine patients had a zero HLA-DR mismatch 
      compared with 52 with one mismatch and 59 patients completely mismatched for DR 
      antigens. RESULTS: There was no significant association between the degree of HLA 
      mismatch for either class I or class II antigens whether the loci were considered 
      alone or in combination (ie, A, B, DR, AB, or ABDR mismatching) with markers of 
      long-term valve function including patient mortality, reoperation, valve 
      degeneration, valve stenosis, presence of regurgitation, and postoperative New 
      York Heart Association class. One hundred thirty-six of 167 (82%) were found to 
      have produced antibodies after operation (mean time after operation, 6.42+/-0.58 
      years). In 61 cases both antibody specificity and donor HLA typing was available. 
      In 92% of these, the antibodies were of the IgG subclass and were specific for 
      the HLA class I molecules of the donor. The presence of HLA antibodies was 
      associated with an increase in the frequency of mild valve stenosis (not 
      significant) compared with those patients who did not develop HLA antibodies 
      (antibody negative = 9.7%; panel reactive antibodies <50% = 29.1%; and panel 
      reactive antibodies >50% = 22.2%; not significant). There was also an increased 
      prevalence of valve degeneration associated with HLA antibodies. The actuarial 
      freedom from valve degeneration for the 35 HLA antibody-negative patients was 
      100% at 1, 5, and 10 years compared with 100% at 1 year, 97% at 5 years, and 92% 
      at 10 years for 55 patients with panel reactivity less than 50%, and 98% at 1 
      year, 94% at 5 years, and 88% at 10 years for the 77 patients who were highly 
      sensitized (not significant). There was no correlation with other markers of 
      long-term valve function. CONCLUSIONS: The influence of the immune response on 
      valve function requires further studies involving large numbers of patients 
      followed for a longer period of time. We believe prospective matching for HLA 
      antigens is warranted to produce a well-matched cohort of patients for analysis 
      and to reduce antibody sensitization, which would help to clarify this issue.
FAU - Smith, J D
AU  - Smith JD
AD  - Department of Cardiothoracic Surgery, Imperial College of Science and Technology, 
      National Heart and Lung Institute, Harefield Hospital, Middlesex, United Kingdom.
FAU - Hornick, P I
AU  - Hornick PI
FAU - Rasmi, N
AU  - Rasmi N
FAU - Rose, M L
AU  - Rose ML
FAU - Yacoub, M H
AU  - Yacoub MH
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
RN  - 0 (Antibodies)
RN  - 0 (HLA Antigens)
RN  - 0 (HLA-A Antigens)
RN  - 0 (HLA-B Antigens)
RN  - 0 (HLA-DR Antigens)
RN  - 0 (Immunoglobulin G)
SB  - IM
MH  - Actuarial Analysis
MH  - Antibodies/*analysis
MH  - Antibody Specificity
MH  - Aortic Valve/physiology/*transplantation
MH  - Aortic Valve Insufficiency/etiology
MH  - Aortic Valve Stenosis/etiology
MH  - Chromosome Mapping
MH  - Cohort Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Graft Survival
MH  - HLA Antigens/*immunology
MH  - HLA-A Antigens/genetics/immunology
MH  - HLA-B Antigens/genetics/immunology
MH  - HLA-DR Antigens/genetics/immunology
MH  - *Histocompatibility
MH  - Humans
MH  - Immunoglobulin G/analysis
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications
MH  - Prospective Studies
MH  - Reoperation
MH  - Risk Factors
MH  - Survival Rate
MH  - Tissue Preservation
MH  - *Transplantation Immunology
MH  - Transplantation, Homologous
EDAT- 1999/02/04 00:00
MHDA- 1999/02/04 00:01
CRDT- 1999/02/04 00:00
PHST- 1999/02/04 00:00 [pubmed]
PHST- 1999/02/04 00:01 [medline]
PHST- 1999/02/04 00:00 [entrez]
AID - S0003-4975(98)01115-1 [pii]
AID - 10.1016/s0003-4975(98)01115-1 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 1998 Dec;66(6 Suppl):S212-5. doi: 10.1016/s0003-4975(98)01115-1.