Human leukocyte antigen mismatch on lung transplantation outcomes

Firoz, Ahad; Kashem, Mohammed; Zhao, Huaqing; Geier, Steven S.; Toyoda, Yoshiya

doi:10.1093/ejcts/ezac132

Cited by 6 publications

(2 citation statements)

References 21 publications

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“…The impact on renal survival has still been maintained since the last two decades [30], except between 1994 and 1998 [31]. The reasons for this individual impact of HLA-DR with respect to the other two types of mismatches are under study [32], being also common in transplants of other organs. Some authors [33] postulate that DR antigens may be more immunogenic than A or B antigens.…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of the Impact of Human Leukocyte Antigens on Renal Transplant Survival in Andalusia and the United States

et al. 2023

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Renal transplantation is the treatment of choice for patients suffering from chronic renal disease, one of the leading causes of death worldwide. Among the biological barriers that may increase the risk of acute renal graft rejection is the presence of human leukocyte antigen (HLA) incompatibilities between donor and recipient. This work presents a comparative study of the influence of HLA incompatibilities on renal transplantation survival in the Andalusian (South of Spain) and United States (US) population. The main objective is to analyse the extent to which results about the influence of different factors on renal graft survival can be generalised to different populations. The Kaplan–Meier estimator and the Cox model have been used to identify and quantify the impact on the survival probability of HLA incompatibilities, both in isolation and in conjunction with other factors associated with the donor and recipient. According to the results obtained, HLA incompatibilities considered in isolation have negligible impact on renal survival in the Andalusian population and a moderate impact in the US population. Grouping by HLA score presents some similarities for both populations, while the sum of all HLA scores (aHLA) only has an impact on the US population. Finally, the graft survival probability of the two populations differs when aHLA is considered in conjunction with blood type. The results suggest that the disparities in the renal graft survival probability between the two populations under study are due not only to biological and transplantation-associated factors, but also to social–health factors and ethnic heterogeneity between populations.

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Section: Discussionmentioning

confidence: 99%

Comparative Study of the Impact of Human Leukocyte Antigens on Renal Transplant Survival in Andalusia and the United States

et al. 2023

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“…3,4 It remains controversial whether HLA mismatches between donors and recipients (D/R HLA mismatches) influence postoperative outcomes of LTx including chronic lung allograft dysfunction (CLAD). [5][6][7][8][9] Previously, we reported a higher frequency of dnDSA development in recipients who had undergone deceased-donor lung transplantations than in those who had undergone LDLLTs. 10 One possible reason for the results in that report was the differences in the D/R HLA mismatches between recipients who had undergone deceased-donor lung transplantations and LDLLTs.…”

Section: Introductionmentioning

confidence: 96%

Impact of Spousal Donation on Postoperative Outcomes of Living-donor Lobar Lung Transplantation

et al. 2023

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Background. The effect of human leukocyte antigen mismatches between donors and recipients on postoperative outcomes of lung transplantation remains controversial. We retrospectively reviewed adult recipients receiving living-donor lobar lung transplantation (LDLLT) to examine the difference in de novo donor-specific antibody (dnDSA) development and clinically diagnosed unilateral chronic lung allograft dysfunction per graft (unilateral CLAD) between lung grafts donated by spouses (nonblood relatives) and nonspouses (relatives within the third degree). We also investigated the difference in prognoses between recipients undergoing LDLLTs including spouse donors (spousal LDLLTs) and not including spouse donors (nonspousal LDLLTs). Methods. In this study, 63 adult recipients undergoing LDLLTs (61 bilateral and 2 unilateral LDLLTs from 124 living donors) between 2008 and 2020 were enrolled. The cumulative incidence of dnDSAs per lung graft was calculated, and prognoses were compared between recipients undergoing spousal and nonspousal LDLLTs. Results. The cumulative incidence of both dnDSAs and unilateral CLAD in grafts donated by spouses was significantly higher than that in grafts donated by nonspouses (5-y incidence of dnDSAs: 18.7% versus 6.4%, P = 0.038; 5-y incidence of unilateral CLAD: 45.6% versus 19.4%, P = 0.011). However, there were no significant differences in the overall survival or chronic lung allograft dysfunction-free survival between recipients undergoing spousal and nonspousal LDLLTs (P > 0.99 and P = 0.434, respectively). Conclusions. Although there were no significant differences in prognoses between spousal and nonspousal LDLLTs, more attention should be paid to spousal LDLLTs because of the higher development rate of dnDSAs and unilateral CLAD.

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Influence of HLA mismatch between donors and recipients on postoperative outcomes in cadaveric lung transplantation

Kayawake,

Sakanoue,

Tanaka

et al. 2024

Gen Thorac Cardiovasc Surg

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Objectives Generally, HLA matching between donors and recipients is not performed in lung transplantation (LTx). Therefore, whether HLA mismatch between donors and recipients (D/R mismatch) influences postoperative outcomes after LTx remains uncertain. In this study, we investigated the influence of D/R mismatch on postoperative outcomes after cadaveric LTx (CLT). Methods A total of 140 CLT procedures were performed between 2012 and 2020. After excluding 5 recipients with preformed DSA and 1 recipient undergoing re-LTx, 134 recipients were enrolled in this retrospective study. The postoperative outcomes were compared between recipients with higher and lower D/R mismatches. Results The median D/R mismatch (A/B/DR loci) was 4.0 (range, 1–6). When dividing these 134 recipients into two groups (H group [D/R mismatch ≥ 5, n = 57] and L group [D/R mismatch ≤ 4, n = 77]), there were no significant differences in the patient backgrounds. The lengths of hospital and intensive care unit stays were similar (p = 0.215 and p = 0.37, respectively). Although the overall survival was not significantly better in the H group than in the L group (p = 0.062), chronic lung allograft dysfunction-free survival was significantly better in the H group than in the L group (p = 0.027). Conversely, there was no significant difference in the cumulative incidence of de novo donor-specific anti-HLA antibodies (dnDSAs) between the two groups (p = 0.716). Conclusions No significant difference in dnDSA development was observed between patients with higher and lower D/R HLA mismatches. Given the favorable outcomes in the high HLA mismatch group, CLTs can be performed safely in recipients with high D/R HLA mismatches.

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Human leukocyte antigen mismatch on lung transplantation outcomes

Cited by 6 publications

References 21 publications

Comparative Study of the Impact of Human Leukocyte Antigens on Renal Transplant Survival in Andalusia and the United States

Comparative Study of the Impact of Human Leukocyte Antigens on Renal Transplant Survival in Andalusia and the United States

Impact of Spousal Donation on Postoperative Outcomes of Living-donor Lobar Lung Transplantation

Influence of HLA mismatch between donors and recipients on postoperative outcomes in cadaveric lung transplantation

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