Tissue typing, heart and heart-lung transplantation

The effects of HLA matching and the presence of pre-existing anti-HLA antibodies, together with cross-match results, on heart and heart-lung transplants are discussed. Prospective HLA matching of donor and recipient is not usually performed for heart and heart-lung transplants. In a multi-centre study statistically significant improved survival with the better-matched heart grafts was found. In a small series of heart grafts it was also found that the improvement with HLA matching was confined to male recipients who were not blood group O. Heart graft recipients with wide panel reactive antibody had worse graft survival one year after transplant than the unsensitized. In several studies patients with a positive cross-match had a significantly lower survival rate than those with a negative cross-match. It is suggested that, minimally, pre-transplant screening and prospective cross-matching of highly sensitised patients is necessary.