title: Impact of human leukocyte antigen mismatching on outcomes of living donor liver transplantation for primary biliary cirrhosis.
abstract: Patient selection criteria of deceased donor liver transplantation for primary biliary cirrhosis (PBC) are almost completely established. The aim of this study was to establish selection criteria for both patients and donors of living donor liver transplantation (LDLT) for PBC. We used univariate and multivariate analyses to examine patient and donor characteristics of our first 50 cases of LDLT for PBC to elucidate factors that significantly impacted patient survival or disease recurrence after LDLT in the univariate and/or multivariate analyses. Multivariate analysis demonstrated that the presence of persistent ascites before LDLT, a higher number of human leukocyte antigen (HLA)-A, -B, and -DR mismatches between donor and recipient, and donor age >or=50 years were factors significantly associated with early posttransplant death. Independent risk factors for PBC recurrence after LDLT were a lower number of HLA mismatches between donor and recipient, and a lower average trough level of tacrolimus within 1 year after LDLT. Specifically, the lower the number of HLA-A, -B, and -DR mismatches or the average trough level of tacrolimus within 1 year after LDLT, the higher the possibility of developing a recurrence of PBC. In conclusion, the absence of persistent ascites before LDLT, a lower number of HLA-A, -B, and -DR mismatches between donor and recipient, and a younger donor (<50 years) are preferred for gaining acceptable survival outcomes for the transplant. However, a lower number of HLA-A, -B, and -DR mismatches between donor and recipient may be a risk factor for PBC recurrence.
authors.affiliation: Organ Transplant Unit, Kyoto University Hospital, Kyoto. dmorioka@hotmail.com
authors.forename: Daisuke
authors.initials: D
authors.lastname: Morioka
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Tomoyasu
authors.initials: T
authors.lastname: Jo
authors.forename: Seisuke
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogura
authors.forename: Hironori
authors.initials: H
authors.lastname: Haga
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000378:metabolism*; D006650:Histocompatibility Testing; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000235:genetics / Q000401:mortality* / Q000601:surgery* / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens