Combined HLA-DR and -DQ disparity is associated with a stable course of ulcerative colitis after liver transplantation for primary sclerosing cholangitis.
Combined disparity of human leukocyte antigen (HLA)-DR and -DQ between mother and fetus is associated with less severe ulcerative colitis (UC) during pregnancy. We evaluated whether donor-recipient HLA disparity after liver transplantation (LT) affects UC in patients with primary sclerosing cholangitis (PSC). Sixty-nine consecutive patients with PSC underwent LT; all underwent colonoscopy before LT; 48 had UC before and 3 had de novo UC after LT. Clinical and laboratory data, activity and treatment of UC, post-LT cytomegalovirus infection, and disparity of HLA-A, -B, -DR, and -DQ for each donor-recipient pair were evaluated. Pre-LT quiescent UC was present in 26 patients. Post-LT UC activity was evaluated in 36 of 51 patients with UC who had not undergone pre-LT colectomy and who had >12 months' post-LT survival. Of these, 16 were stable, 17 had worsened, and 3 had de novo UC. Seven required colectomy (4 for dysplasia or cancer) after LT. Post-LT cytomegalovirus viremia was neither associated with worse UC activity (P = 0.58) nor de novo UC. Disparity with respect to HLA-A, -B, -DR, and -DQ was found in 58%, 27%, 44%, and 39% donor-recipient pairs, respectively. Post-LT UC course was similar with respect to single HLA disparity. However, disparity in none or only one HLA-DR or -DQ was significantly associated with worse activity compared with patients with disparity at both (65% vs. 0%, P = 0.009). Logistic regression found that the disparity for both -DR and -DQ was the only factor statistically significantly associated with post-LT UC activity. We conclude that disparity in both HLA-DR and -DQ between donor and recipient is associated with stable UC activity after LT.
Cholongitas
Evangelos
E
Liver Transplantation and Hepatobiliary Unit, Royal Free Hospital, Hampstead, London, UK.
Papatheodoridis
George V
GV
Zappoli
Paola
P
Giannakopoulos
Athanasios
A
Patch
David
D
Marelli
Laura
L
Shusang
Vibhakorn
V
Kalambokis
George
G
Shirling
Graham
G
Rolando
Nancy
N
Burroughs
A K
AK
D000293:Adolescent; D000328:Adult; D000368:Aged; D018281:Cholangiocarcinoma / Q000453:epidemiology; D015209:Cholangitis, Sclerosing / Q000601:surgery*; D003093:Colitis, Ulcerative / Q000276:immunology*; D005260:Female; D006683:HLA-DQ Antigens / Q000276:immunology*; D006684:HLA-DR Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000276:immunology*; D012189:Retrospective Studies; D016896:Treatment Outcome
D006683:HLA-DQ Antigens; D006684:HLA-DR Antigens