Impact of HLA compatibility on lung transplant survival and evidence for an HLA restriction phenomenon: a collaborative transplant study report.
BACKGROUND
Data concerning the impact of human leukocyte antigen (HLA) compatibility on lung transplant survival rates are limited.


METHODS
Using the Collaborative Transplant Study database, 5-year graft outcome according to HLA mismatch was examined in 8020 deceased donor lung transplants performed during 1989 to 2009.


RESULTS
Graft survival rates showed a stepwise decrease as the combined number of HLA-A+B+DR mismatches increased from one to six (P<0.001). Surprisingly, the 28 grafts with 0 mismatches at all 3 loci had a 1-year survival rate of only 49.7%, significantly lower than for 1, 2, 3, 4, 5, or 6 mismatches (P=0.002, <0.001, <0.001, <0.001, 0.002, and 0.003, respectively). Multivariate regression analysis confirmed that, paradoxically, transplantation of grafts with zero HLA-A+B+DR mismatches was associated with a 19% increase in relative risk of failure. Donor lung preservation for up to 12 hr was not associated with inferior graft survival versus shorter preservation times (P=0.60).


CONCLUSIONS
Our data show that a high number of HLA mismatches or zero mismatches impacts unfavorably on lung transplant survival.
Opelz
Gerhard
G
Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany. gerhard.opelz@med.uni-heidelberg.de
Süsal
Caner
C
Ruhenstroth
Andrea
A
Döhler
Bernd
B
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006085:Graft Survival / Q000276:immunology* / Q000502:physiology; D006680:HLA Antigens / Q000276:immunology*; D015234:HLA-A Antigens / Q000276:immunology; D015235:HLA-B Antigens / Q000276:immunology; D006684:HLA-DR Antigens / Q000276:immunology; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D016040:Lung Transplantation / Q000276:immunology* / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome
D006680:HLA Antigens; D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006684:HLA-DR Antigens