Relative impact of human leukocyte antigen mismatching and graft ischemic time after lung transplantation.
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.
Brugière
Olivier
O
Hôpital Bichat, Paris, France. olivier.brugiere@bch.aphp.fr
Thabut
Gabriel
G
Suberbielle
Caroline
C
Reynaud-Gaubert
Martine
M
Thomas
Pascal
P
Pison
Christophe
C
Saint Raymond
Christel
C
Mornex
Jean-François
JF
Bertocchi
Michèle
M
Dromer
Claire
C
Velly
Jean-François
JF
Stern
Marc
M
Philippe
Bruno
B
Dauriat
Gaëlle
G
Biondi
Giuseppina
G
Castier
Yves
Y
Fournier
Michel
M
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
D006680:HLA Antigens