title: The influence of human leukocyte antigen matching on outcomes in pediatric heart transplantation.
abstract: Previous adult heart transplantation studies have demonstrated that donor-recipient human leukocyte antigen (HLA) matching results in reduced graft failure and improved patient survival. No study has examined these effects in children. This study investigated the effect of HLA matching on outcomes in pediatric heart transplantation. All pediatric heart transplantation data for patients 0-18 years of age available from the United Network for Organ Sharing Transplant Registry from 1987 to 2009 were analyzed retrospectively. Donor-recipient HLA matching at loci A, B, and DR (0-6) was compared with graft survival and recipient survival. For this study, 3,751 pediatric cardiac transplantation events with complete HLA matching data were identified and grouped as having 0 to 2 matches (3,416 events) or 3 to 6 matches (335 events). The 3- to 6-match group had less graft failure than the 0- to 2-match group (28.7% vs 34.4%; p = 0.035) and greater patient survival by 5 years (81% vs 72%; p = 0.045) and 10 years (66% vs 55%; p = 0.005) after transplantation. The HLA-DR matching alone resulted in less graft failure (p = 0.038) and improved patient survival (p = 0.017). A higher degree of HLA matching in pediatric heart transplantation is associated with decreased graft failure and improved patient survival. In this study, decreased graft failure rates and superior survival also were seen with DR matching alone.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, 9000 W. Wisconsin Avenue, MS 713, Milwaukee, WI, 53226, USA, sginde@chw.org.
authors.forename: Salil
authors.initials: S
authors.lastname: Ginde
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Ellis
authors.forename: Melodee
authors.initials: M
authors.lastname: Nugent
authors.forename: Pippa
authors.initials: P
authors.lastname: Simpson
authors.forename: Gail
authors.initials: G
authors.lastname: Stendahl
authors.forename: Stuart
authors.initials: S
authors.lastname: Berger
authors.forename: Steven
authors.initials: S
authors.lastname: Zangwill
mesh_terms: D000293:Adolescent; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D006331:Heart Diseases / Q000601:surgery; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D006648:Histocompatibility; D006650:Histocompatibility Testing / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D006680:HLA Antigens
references.citation: Transplant Proc. 2005 Nov;37(9):4001-5
references.pmid: 16386610
references.citation: J Heart Lung Transplant. 1994 Jul-Aug;13(4):583-95; discussion 595-6
references.pmid: 7947874
references.citation: Circulation. 1996 Jul 15;94(2):170-4
references.pmid: 8674175
references.citation: Transplant Proc. 1998 Aug;30(5):1917-9
references.pmid: 9723332
references.citation: J Heart Lung Transplant. 1999 Mar;18(3):226-30
references.pmid: 10328148
references.citation: Transplantation. 2000 May 27;69(10):2178-86
references.pmid: 10852620
references.citation: Transplantation. 1999 Aug 27;68(4):515-9
references.pmid: 10480409
references.citation: N Engl J Med. 1994 Mar 24;330(12):816-9
references.pmid: 8068075
references.citation: Transplant Proc. 1991 Feb;23(1 Pt 2):1139-41
references.pmid: 1989171
references.citation: J Heart Lung Transplant. 2006 Sep;25(9):1057-62
references.pmid: 16962466
references.citation: J Heart Lung Transplant. 2010 Oct;29(10):1119-28
references.pmid: 20870166
references.citation: Transplant Proc. 2007 Jun;39(5):1575-9
references.pmid: 17580192