The effect of donor against recipient one-way HLA mismatch on liver transplantation outcomes from a multicenter...

Area of Science:

• Transplantation Immunology
• Hepatology

Background:

• Donor against recipient one-way Human Leukocyte Antigen (HLA) mismatch (D→R one-way HLA MM) is associated with graft-versus-host disease (GVHD).
• The impact of D→R one-way HLA MM on liver transplantation (LT) outcomes requires further investigation.

Purpose of the Study:

• To investigate the clinical relevance of D→R one-way HLA MM in liver transplantation (LT).
• To evaluate the association between D→R one-way HLA MM and patient outcomes, including GVHD and mortality.

Main Methods:

• Retrospective analysis of 2670 patients undergoing LT between April 2014 and December 2020 from the Korean Organ Transplantation Registry database.
• Patients were categorized into groups based on the presence or absence of D→R one-way HLA MM.
• Outcomes including GVHD incidence, mortality rates, overall survival, rejection-free survival, and death-censored graft survival were compared between groups.

Main Results:

• Eighteen patients (0.67%) exhibited D→R one-way HLA MM.
• The D→R one-way HLA MM group showed significantly higher incidence of GVHD (22.2% vs. 0.3%) and mortality (38.9% vs. 11.6%).
• D→R one-way HLA MM at 3 loci was a strong risk factor for GVHD (OR 163.3) and patient death (HR 12.75), leading to significantly lower overall survival (p<0.001).

Conclusions:

• D→R one-way HLA MM at 3 loci is a significant risk factor impacting overall survival and GVHD incidence in liver transplant recipients.
• The presence of D→R one-way HLA MM negatively affects patient survival post-LT.
• No significant differences were observed in rejection-free survival and death-censored graft survival between groups.