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HLA histocompatibility affects cardiac transplant rejection and may provide one basis for organ allocation
V J DiSesa1, P C Kuo, K A Horvath
1Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115.
Insights
Prospective human lymphocyte antigen (HLA) matching for heart transplants may reduce rejection episodes. Achieving two or more HLA-A or HLA-B matches correlated with fewer rejections and less steroid-resistant rejection.
Area of Science:
- Immunology
- Transplantation Medicine
- Cardiology
Background:
- Prospective human lymphocyte antigen (HLA) typing is not standard practice in heart transplantation.
- The relationship between HLA matching and cardiac graft rejection remains unclear.
Purpose of the Study:
- To retrospectively analyze the impact of recipient and donor HLA matching on cardiac graft rejection.
- To investigate the correlation between HLA matching and the incidence of steroid-resistant rejection.
Main Methods:
- Retrospective analysis of 51 patients undergoing orthotopic cardiac transplantation.
- HLA typing (broad specificities) and analysis of HLA-A, HLA-B, and HLA-DR matches.
- Assessment of rejection episodes and steroid-resistant rejection over a mean follow-up of 34 months.
Main Results:
- Patients with two or more HLA-A or HLA-B matches experienced significantly fewer rejection episodes (3/10 vs. 19/34).
- A lower incidence of steroid-resistant rejection was observed in patients with two or more HLA-A or HLA-B matches (1/10 vs. 18/34; p = 0.01).
- Increased rejection frequency strongly correlated with steroid-resistant rejection (p < 0.0001).
Conclusions:
- Prospective HLA matching is feasible with current typing methods.
- Results support the rationale for prospective histocompatibility testing in cardiac transplantation.
- Donor heart allocation to recipients with two or more HLA matches may improve outcomes.
Abstract:
Prospective human lymphocyte antigen (HLA) typing is not performed for heart transplantation, and the relation between HLA matching and cardiac graft rejection is unclear. Recipient and donor HLA matching were analyzed retrospectively in 51 patients undergoing orthotopic cardiac transplantation. Immunosuppression was based on cyclosporine and prednisone. During the mean follow-up of 34 months (range, 16 to 63 months), the 46 operative survivors had an average of 3.95 rejection episodes (range, zero to 11 episodes). Twenty-one patients had steroid-resistant rejection requiring treatment with polyclonal or monoclonal antithymocyte globulin. Human lymphocyte antigen typing was available for 44 patients, and antigens were grouped in broad specificities. Patients with two or more HLA-A or HLA-B matches had a reduced number of rejection episodes (3/10 versus 19/34) and a lower incidence of steroid-resistant rejection (1/10 versus 18/34; p = 0.01). Inclusion of HLA-DR matches did not alter the findings. There was a strong correlation between the increased frequency of rejection and the incidence of steroid-resistant rejection (p less than 0.0001). Four of six late deaths occurred in patients with steroid-resistant rejection; four were due to acute rejection and two to graft atherosclerosis. Although not currently done, prospective HLA matching is feasible with present typing methods. Our results suggest a rationale for prospective histocompatibility testing in cardiac transplantation with allocation of donor hearts to patients with two or more HLA matches.