title: The impact of HLA A, B, and DR blood transfusions and immune responder status on cardiac allograft recipients treated with cyclosporine.
abstract: From July 1982 to August 1986, 137 patients received heart allografts at our transplant (Tx) center. Recipients were treated postoperatively with cyclosporine (CsA) and prednisone (Pred), with a minority of patients receiving CsA, Pred, and azathioprine (Aza) as immunosuppression. The impact of pre-Tx immune factors on survival was evaluated, including HLA A, B, and DR mismatches (MM), blood transfusions (BT), immune responder status, crossmatch results, and donor and recipient AIDS-virus (human immunodeficiency virus, HIV-1) status. The overall patient survivals were 75%, 68%, and 62% at one, two, and three years respectively. Pre-Tx, 15/137 (11%) recipient sera and 5/137 (3.6%) donor sera were HIV-1 reactive in both enzyme immunoassay (EIA) and Western blot antibody assays. Two of the 5 recipients of HIV-1 (+) donor allografts are alive 11 and 29 months post-Tx, whereas the other 3 recipients died at 1, 31, and 36 months post-Tx from diseases unrelated to AIDS. All 5 were pre-Tx HIV-1 nonreactive. The survivals for the 15 recipients who tested pre-Tx HIV-1 (+) were 87%, 87%, and 69% at 1, 2, and 3 years, respectively, comparable to the overall group survivals. Pre-Tx strong and weak immune responders had comparable 12-month survivals of 73% and 80%, respectively. Six patients displayed a positive pre-Tx donor crossmatch, two were attributed to autoantibody, and 4 were attributed to donor T cell reactivity. Five of the six patients presently survive 14, 16, 30, 36, and 44 months post-Tx. Recipients treated pre-Tx with 1-4 BTs displayed significantly better 12-month survival (81% vs. 69%, P less than 0.05) and fewer rejections (1.3 +/- 0.9 vs. 1.9 +/- 1.0, P less than 0.05) than untransfused recipients. Recipients of a 0-1 vs. 2 DR donor antigen-mismatch experienced fewer rejections (1.3 +/- 1.0 vs. 1.8 +/- 1.1, P less than 0.05). Evaluation of the combined influence of HLA DR as well as pre-Tx BTs suggested a significantly improved survival (80% vs. 61%, P less than 0.05) and fewer rejection episodes (1.4 +/- 0.9 vs. 2.0 +/- 1.1, P less than 0.05) for 29 well-matched, transfused (0-1 DR MM and 1-4 BT) compared with 43 poorly matched, untransfused (2 DR MM and 0-BT) heart allograft recipients. Moreover, the benefit of DR matching was only observed in untransfused, but not transfused, cardiac recipients.
authors.affiliation: Department of Surgery, University of Texas Medical School, Houston 77030.
authors.forename: R H
authors.initials: RH
authors.lastname: Kerman
authors.forename: C T
authors.initials: CT
authors.lastname: van Buren
authors.forename: R M
authors.initials: RM
authors.lastname: Lewis
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
authors.forename: D
authors.initials: D
authors.lastname: Cooley
authors.forename: B D
authors.initials: BD
authors.lastname: Kahan
mesh_terms: D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D003524:Cyclosporins / Q000627:therapeutic use*; D005260:Female; D006085:Graft Survival / Q000187:drug effects; D006679:HIV Seropositivity; D006680:HLA Antigens / Q000276:immunology*; D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006681:HLA-D Antigens / Q000276:immunology*; D006684:HLA-DR Antigens / Q000276:immunology*; D016027:Heart Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects; D007223:Infant; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D013601:T-Lymphocytes / Q000145:classification; D065227:Transfusion Reaction; D014184:Transplantation, Homologous / Q000401:mortality
chemical_list: D003524:Cyclosporins; D006680:HLA Antigens; D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006681:HLA-D Antigens; D006684:HLA-DR Antigens