Human leukocyte antigen compatibility in heart-lung transplantation

The relationship of heart-lung allograft-related death and obliterative bronchiolitis (OB) to human leukocyte antigen (HLA) matching was studied in 40 consecutive heart-lung transplant patients operated on between March 1981 and September 1986. Mismatch was defined as an antigen present in the donor but not in the recipient. Patients with only one antigen identified at a given locus were presumed to be homozygous for that antigen. The results were obtained from the patients who survived more than 3 months after surgery. The patients with zero to one mismatches in the HLA locus A (10 patients) had a tendency toward less OB, less severe OB, and fewer deaths from OB than the patients (15) with two mismatches in HLA locus A. However, only graded OB (1, mild; 2, moderate; 3, severe) was significantly different (p = 0.05) in these groups. There was one patient with no A locus mismatches; she survived 62 months, and no OB was found at her autopsy. This limited experience suggests that HLA-A locus match may have a salutary effect on long-term results and that OB may be at least partly a result of chronic rejection.