HLA-DR matching improves survival after heart transplantation: is it time to change allocation policies?
BACKGROUND
HLA matching has improved outcome in kidney transplantation but is not considered in current allocation policies in heart transplantation. The aim of this single-center study was to assess the impact of HLA matching on long- term outcome after heart transplantation.


METHODS
The records of 240 consecutive heart transplant recipients (time period 1995 to 2002; mean age 51.8 +/- 11.7 years; mean follow-up 5.9 +/- 1.8 years) were analyzed retrospectively. According to the renal allocation policy, HLA mismatches (MM) on the major antigen loci HLA-A, HLA-B and HLA-DR were calculated, demonstrating 0 to 6 MM. Patients with primary graft failure were excluded from statistical analysis.


RESULTS
Survival analysis revealed a statistically significant impact of HLA-DR MM on survival. Five-year survival was 90% in patients without HLA-DR MM (n = 10), 79% in patients with 1 HLA-DR MM (n = 113), and 68.1% in patients with 2 HLA-DR MM (n = 117) (1 MM vs 2 MM: p < 0.05). Freedom from cardiac allograft vasculopathy after 5 years was 89% in HLA-DR-identical recipients (n = 10), 61% in patients with 1 HLA-DR MM (n = 102), 54% in patients with 2 HLA-DR MM (n = 104). Conventional matching with 6 mismatches over the three major HLA antigen loci revealed a trend toward a higher relative risk for adverse outcome in patients with increased MM.


CONCLUSIONS
HLA-DR matching had a significant impact on survival after heart transplantation (HTx) at our center. In the effort to achieve the best comparative use of scarce donor organs the inclusion of HLA-DR matching into allocation policies might improve long-term outcome after HTx.
Kaczmarek
Ingo
I
Department of Cardiac Surgery, Grosshadern University Hospital, Munich, Munich, Germany.
Deutsch
Marcus-Andre
MA
Rohrer
Maria-Elisabeth
ME
Beiras-Fernandez
Andres
A
Groetzner
Jan
J
Daebritz
Sabine
S
Schmoeckel
Michael
M
Spannagl
Michael
M
Meiser
Bruno
B
Reichart
Bruno
B
D000328:Adult; D005260:Female; D005838:Genotype; D006084:Graft Rejection / Q000235:genetics / Q000276:immunology; D006085:Graft Survival / Q000235:genetics / Q000276:immunology*; D006684:HLA-DR Antigens / Q000235:genetics / Q000276:immunology*; D016027:Heart Transplantation / Q000276:immunology*; D006648:Histocompatibility / Q000235:genetics / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D040841:Resource Allocation / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D009927:Tissue and Organ Procurement / Q000379:methods; D023001:Transplantation Tolerance / Q000235:genetics / Q000276:immunology; D016896:Treatment Outcome
D006684:HLA-DR Antigens