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Histocompatibility and liver transplantation
S J Knechtle1, M Kalayolu, A M D'Alessandro
1Department of Surgery, University of Wisconsin Hospital, Madison 53792.
Background:
The role of histocompatibility between donor and recipient in liver transplant rejection is unclear because of a paucity of data. The influence of human leukocyte antigen (HLA) type on immunologic graft loss was examined for primary liver transplantations performed at this center.
Methods:
Immunologic graft loss included patient death or retransplantation as a result of rejection or impending graft loss caused by either late hepatic artery thrombosis or severe, unremitting rejection requiring FK 506 rescue therapy. HLA A, B, and DR matching was available on 205 donor-recipient combinations, and an additional 31 patients had A and B matching only.
Results:
A mismatch of class I antigens (HLA A and B) was predictive of immunologic graft loss (p = 0.018). DR mismatch did not correlate with graft loss. When the A and B loci were analyzed separately, an A mismatch correlated significantly with immunologic graft loss (p = 0.02), in contrast to a B mismatch (p = 0.17). Better matching significantly improved patient survival (p = 0.02) and overall graft survival (p = 0.009).
Conclusions:
The beneficial effect of HLA class I antigen compatibility on liver transplantation outcome is in contrast to pancreatic and kidney transplantation in which class II antigen matching but not class I matching is beneficial. Immunologic mechanisms of hepatic allograft rejection may differ from those involved in kidney transplant rejection.