Impact of human leukocyte antigen mismatching on outcomes of liver transplantation: a meta-analysis.
OBJECTIVE
To assess the effect of human leukocyte antigen (HLA) mismatching on liver graft outcome and acute rejection from a meta-analysis of available cohort studies.


METHODS
Articles in PubMed/MEDLINE, EMBASE and the Cochrane database from January 1970 to June 2009, including non-English literature identified in these databases, were searched. Only studies comparing HLA or sub-phenotype matching with mismatching were extracted. The percentage of graft survival was extracted by "Engauge Digitizer" from survival curves if the raw data were not displayed. A meta-analysis was performed when at least 3 studies provided data.


RESULTS
Sixteen studies met the inclusion criteria. A lower number of HLA mismatches (0-2 vs 3-6) did reduce the incidence of acute rejection (relative risk: 0.77, P = 0.03). The degree of HLA mismatching (0-2 vs 3-6) had no significant effect on 1-year [hazard ratio (HR): 1.04, P = 0.68] and 5-year (HR: 1.09, P = 0.38) graft survival. In sub-phenotype analysis, the degree of HLA-A, B and DR mismatching (0 vs 1-2) had no significant effect on 1-year and 5-year graft survival, either. The HRs and P-values were 0.95, 0.71 (HLA-A, 1-year); 1.06, 0.60 (HLA-A, 5-year); 0.77, 0.16 (HLA-B, 1-year); 1.07, 0.56 (HLA-DR, 1-year); 1.18, 0.23 (HLA-DR, 5-year), respectively.


CONCLUSIONS
The results of this systematic review imply that good HLA compatibility can reduce the incidence of acute rejection in spite of having no influence on graft outcomes. To obtain a short recovery time and minimize rejection post transplantation, HLA matching studies should be considered before the operation.
Lan
Xiang
X
Department of Hepatobiliary Surgery and Liver Transplantation Centre, Children's Hospital of Chongqing Medical University, 136, Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China.
Zhang
Ming-Man
MM
Pu
Cong-Lun
CL
Guo
Chun-Bao
CB
Kang
Quan
Q
Li
Ying-Chun
YC
Dai
Xiao-Ke
XK
Deng
Yu-Hua
YH
Xiong
Qiang
Q
Ren
Zhi-Mei
ZM
D016208:Databases, Factual; D000939:Epitopes; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology; D016896:Treatment Outcome
D000939:Epitopes; D006680:HLA Antigens