title: The effect of HLA mismatches, shared cross-reactive antigen groups, and shared HLA-DR antigens on the outcome after pediatric liver transplantation.
abstract: The aim of this study was to analyze the effect of human leukocyte antigen (HLA) class I and HLA-DR mismatching, sharing cross-reactive antigen groups (CREGs), and sharing HLA-DR antigens on the outcome after pediatric liver transplantation. Outcome parameters were graft survival, acute rejection, and portal fibrosis. A distinction was made between full-size (FSLTx) and technical-variant liver transplantation (TVLTx). A total of 136 primary transplants were analyzed. The effect of HLA on the outcome parameters was analyzed by adjusted multivariate logistic and Cox regression analysis. HLA mismatches, shared CREGs, and shared HLA-DR antigens affected neither overall graft survival nor survival after FSLTx. Survival after TVLTx was superior in case of 2 mismatches at the HLA-DR locus compared to 0 or 1 mismatch (P = 0.01) and in case of no shared HLA-DR antigen compared to 1 shared HLA-DR antigen (P = 0.004). The incidence of acute rejection was not influenced by HLA. The incidence of portal fibrosis could be analyzed in 62 1-yr biopsies and was higher after TVLTx than FSLTx (P = 0.04). The incidence of portal fibrosis after TVLTx with 0 or 1 mismatch at the HLA-DR locus was 100% compared to 43% with 2 mismatches (P = 0.004). After multivariate analysis, matching for HLA-DR and matching for TVLTx were independent risk factors for portal fibrosis. In conclusion, an overall beneficial effect of HLA matching, sharing CREGs, or sharing HLA-DR antigens was not observed. A negative effect was present for HLA-DR matching and sharing HLA-DR antigens on survival after TVLTx. HLA-DR matching might be associated with portal fibrosis in these grafts.
authors.affiliation: Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Liver Transplant Group, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: Egbert
authors.initials: E
authors.lastname: Sieders
authors.forename: Bouke G
authors.initials: BG
authors.lastname: Hepkema
authors.forename: Paul M J G
authors.initials: PM
authors.lastname: Peeters
authors.forename: Elisabeth M
authors.initials: EM
authors.lastname: TenVergert
authors.forename: Koert P
authors.initials: KP
authors.lastname: de Jong
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Porte
authors.forename: Charles M A
authors.initials: CM
authors.lastname: Bijleveld
authors.forename: Aad P
authors.initials: AP
authors.lastname: van den Berg
authors.forename: Simon P M
authors.initials: SP
authors.lastname: Lems
authors.forename: Annette S H
authors.initials: AS
authors.lastname: Gouw
authors.forename: Maarten J H
authors.initials: MJ
authors.lastname: Slooff
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003429:Cross Reactions / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D006085:Graft Survival; D006684:HLA-DR Antigens / Q000276:immunology*; D015395:Histocompatibility Antigens Class I / Q000276:immunology*; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006684:HLA-DR Antigens; D015395:Histocompatibility Antigens Class I