title: Human leukocyte antigen-DR mismatch is associated with increased in-hospital mortality after a heart transplant.
abstract: OBJECTIVE
  Although previous studies have investigated the effect of human leukocyte antigen matching on long-term outcomes after heart transplants, its role in the prognosis after a heart transplant remains unclear, particularly with respect to short-term survival.
  
  
  METHODS
  We evaluated the human leukocyte antigen mismatch on in-hospital mortality of 158 consecutive patients who had undergone a heart transplant between 2000 and 2008. Human leukocyte antigens-A, -B, and -DR were determined by means of serologic and molecular techniques. Univariate analysis and a multiple logistic regression models evaluated the effect of human leukocyte antigen variants on mortality, independent of clinical variables.
  
  
  RESULTS
  In-hospital mortality was 11.4%. Higher prevalence of acute kidney injury (50.0% vs 12.9%), higher levels of troponins 48 hours after transplant (15.6 ± 12.0 ng/mL vs 9.7 ± 9.4 ng/mL), prolonged ischemia (188.2 ± 32.5 min vs 162.6 ± 40.7 min), higher frequency of reoperation (61.1% vs 17.9%), and higher human leukocyte antigen-DR mismatch (1.61 ± 0.5 vs 1.30 ± 0.6) were found in patients who died. By logistic regression analysis, humanleukocyte antigen-DR mismatch is associated with in-hospital mortality (OR=5.159, 95% CI=1.348-19.754), independent of the effect of covariates such as recipient age, mismatch sex, mismatch human leukocyte antigen-A, human leukocyte antigen-B, acute kidney injury, reoperation, ischemia duration, and levels of troponins.
  
  
  CONCLUSIONS
  Human leukocyte antigen-DR mismatch is associated with in-hospital mortality in heart transplant.
authors.affiliation: Department of General Pathology and Excellence Research Centre on Cardiovascular Diseases, 1st School of Medicine. Second University of Naples, Complesso S. Andrea delle Dame Via Costantinopoli 16, Naples, 80138, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Crudele
authors.forename: Francesco
authors.initials: F
authors.lastname: Cacciatore
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Grimaldi
authors.forename: Ciro
authors.initials: C
authors.lastname: Maiello
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Romano
authors.forename: Cristiano
authors.initials: C
authors.lastname: Amarelli
authors.forename: Antonietta
authors.initials: A
authors.lastname: Picascia
authors.forename: Pasquale
authors.initials: P
authors.lastname: Abete
authors.forename: Claudio
authors.initials: C
authors.lastname: Napoli
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D046148:Donor Selection; D005260:Female; D006684:HLA-DR Antigens / Q000276:immunology*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006648:Histocompatibility; D006650:Histocompatibility Testing; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D006684:HLA-DR Antigens; D014336:Troponin