title: HLA-DRB1 donor-recipient mismatch affects the outcome of hepatitis C disease recurrence after liver transplantation.
abstract: OBJECTIVE
  This study extends our previously reported observations that various immunological factors are associated with the occurrence of histologically proven recurrent hepatitis C. The two specific issues investigated were to confirm the associations of MHC alleles and donor/recipient mismatch with the occurrence of recurrent hepatitis C in an independent cohort of newly transplanted patients and to look for immunologic and nonimmunologic variables affecting the severity of the recurrent disease.
  
  
  METHODS
  Two separate cohorts of consecutive patients were studied: a look-back cohort (LC) of 120 patients and a cohort for studying the disease progression (CSDP) of 190 patients. Protocol liver biopsies were obtained at least 1, 3, 5, 7, and 10 years after liver transplantation (LT).
  
  
  RESULTS
  A fully mismatched donor/recipient pair at the DRB1 locus was confirmed to be associated with both the recurrence of histologic hepatitis in the LC (59% vs 23%, P = .0002) and its progression beyond stage 3 in the CSPD (71.4% vs 39.3%, P = .0003). Relevant immunologic and nonimmunologic variables were included into a multivariate Cox proportional model and three variables, namely, donor age, full HLA-DRB1 donor-recipient mismatch, and HLA B14, resulted in independent risk factors for the development of severe fibrosis.
  
  
  CONCLUSIONS
  This study provides evidence that DRB1 donor-recipient mismatch affects both the occurrence and progression of recurrent hepatitis C disease. This information is clinically relevant as it may help to better allocate organs and to recognize patients at risk for progression so that specific interventions can be implemented.
authors.affiliation: Department of Gastroenterology and Hepatology, "Crespi" Ospedale Niguarda, Milan, Italy. epatogastro@ospedaleniguarda.it
authors.forename: Luca Saverio
authors.initials: LS
authors.lastname: Belli
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.forename: Francesca
authors.initials: F
authors.lastname: Poli
authors.forename: Alberto
authors.initials: A
authors.lastname: Battista Alberti
authors.forename: Enrico
authors.initials: E
authors.lastname: Silini
authors.forename: Claudio
authors.initials: C
authors.lastname: Zavaglia
authors.forename: Stefano
authors.initials: S
authors.lastname: Fagiuoli
authors.forename: Daniela
authors.initials: D
authors.lastname: Prando
authors.forename: Alejandro
authors.initials: A
authors.lastname: Espadas de Arias
authors.forename: Sara
authors.initials: S
authors.lastname: Boninsegna
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.forename: Mario
authors.initials: M
authors.lastname: Scalamogna
authors.forename: Luciano
authors.initials: L
authors.lastname: de Carlis
authors.forename: Giovambattista
authors.initials: G
authors.lastname: Pinzello
mesh_terms: D000328:Adult; D000368:Aged; D000483:Alleles; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D005260:Female; D006684:HLA-DR Antigens / Q000235:genetics*; D059811:HLA-DRB1 Chains; D006526:Hepatitis C / Q000209:etiology*; D006650:Histocompatibility Testing; D006801:Humans; D008103:Liver Cirrhosis / Q000235:genetics; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012008:Recurrence
chemical_list: D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains