title: Relative impact of human leukocyte antigen mismatching and graft ischemic time after lung transplantation.
abstract: BACKGROUND
  Recent data strongly suggest that human leukocyte antigen (HLA) mismatching has a negative impact on development of bronchiolitis obliterans syndrome (BOS) and survival after lung transplantation (LTx). Because HLA matching is sometimes achieved by extending ischemic time in other solid-organ transplantation models and ischemic time is a risk factor per se for death after LTx, we sought to compare the theoretical benefit of HLA matching with the negative impact of lengthened ischemic time.
  
  
  METHODS
  In this collaborative study we compared the relative impact of HLA mismatching and ischemic time on BOS and survival in 182 LTx recipients.
  
  
  RESULTS
  Using multivariate analyses, we observed a lower incidence of BOS (hazard ratio [HR] = 1.70, 95% confidence interval [CI]: 1.1 to 2.7, p = 0.03) and enhanced survival (HR = 1.91, 95% CI: 1.24 to 2.92, p = 0.01) in patients with zero or one HLA-A mismatch compared with those having two HLA-A mismatches. This beneficial effect on survival was equivalent to a reduction of ischemic time of 168 minutes.
  
  
  CONCLUSIONS
  We observed a reduced incidence of BOS and a better survival rate in patients well-matched at the HLA-A locus, associated with an opposite effect of an enhanced ischemic time. This suggests that graft ischemic time should be taken into account in future studies of prospective HLA matching in LTx.
authors.affiliation: Hôpital Bichat, Paris, France. olivier.brugiere@bch.aphp.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Brugière
authors.forename: Gabriel
authors.initials: G
authors.lastname: Thabut
authors.forename: Caroline
authors.initials: C
authors.lastname: Suberbielle
authors.forename: Martine
authors.initials: M
authors.lastname: Reynaud-Gaubert
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
authors.forename: Christophe
authors.initials: C
authors.lastname: Pison
authors.forename: Christel
authors.initials: C
authors.lastname: Saint Raymond
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Mornex
authors.forename: Michèle
authors.initials: M
authors.lastname: Bertocchi
authors.forename: Claire
authors.initials: C
authors.lastname: Dromer
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Velly
authors.forename: Marc
authors.initials: M
authors.lastname: Stern
authors.forename: Bruno
authors.initials: B
authors.lastname: Philippe
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Dauriat
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Biondi
authors.forename: Yves
authors.initials: Y
authors.lastname: Castier
authors.forename: Michel
authors.initials: M
authors.lastname: Fournier
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000276:immunology*; D005260:Female; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens; D006650:Histocompatibility Testing; D006801:Humans; D007511:Ischemia / Q000150:complications*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D006680:HLA Antigens