title: Influence of HLA Mismatching on Survival in Lung Transplantation.
abstract: BACKGROUND
  Data on human leukocyte antigen (HLA) mismatching and survival after lung transplantation (LTx) are variable.
  
  
  METHODS
  The UNOS database was queried from 1987 to 2013 to examine survival associated with total HLA mismatch ≥3 and mismatches of 2 at A, B, and DR loci.
  
  
  RESULTS
  Of 23,528 first-time, adult LTx recipients, 23,384 were included in the univariate Cox analysis, 19,944 in the Kaplan-Meier survival function evaluation, and 16,224 in the multivariate Cox models. Adjusted models found that the total HLA mismatch ≥3 increased the mortality hazard [hazard ratio (HR) 1.214; 95% confidence interval (95% CI) 1.073, 1.374; p = 0.002]. Both HLA-A (HR 1.070; 95% CI 1.023, 1.119; p = 0.003) and HLA-DR (HR 1.053; 95% CI 1.007, 1.101; p = 0.024) were associated with increased mortality risk, but HLA-B (HR 1.006; 95% CI 0.958, 1.056; p = 0.805) was not. Older age, higher creatinine, and higher body mass index were associated with increased risk for death. More recent lung transplant and longer ischemic time were associated with reduced mortality risk. Induction with basiliximab at time of transplant was beneficial by significantly decreasing the risk of death (HR 0.846; 95% CI 0.786, 0.909; p < 0.001).
  
  
  CONCLUSIONS
  HLA mismatching is associated with increased hazard risk for death after LTx, while induction with basiliximab and other factors related to LTx reduce the risk.
authors.affiliation: Section of Pulmonary Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA. hayes.705@osu.edu.|Department of Internal Medicine, The Ohio State University, Columbus, OH, USA. hayes.705@osu.edu.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
authors.affiliation: Department of Surgery, The Ohio State University, Columbus, OH, USA.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Whitson
authors.affiliation: Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.|Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA.
authors.forename: Samir N
authors.initials: SN
authors.lastname: Ghadiali
authors.affiliation: Department of Anesthesiology, The Ohio State University, Columbus, OH, USA.|Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
authors.affiliation: Skaggs Pharmaceutical Sciences Center, The University of Arizona College of Pharmacy, Tucson, AZ, USA.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Mansour
authors.affiliation: Department of Surgery, The Ohio State University, Columbus, OH, USA.
authors.forename: Sylvester M
authors.initials: SM
authors.lastname: Black
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000077552:Basiliximab; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival / Q000276:immunology*; D015234:HLA-A Antigens / Q000276:immunology*; D015235:HLA-B Antigens / Q000276:immunology*; D006684:HLA-DR Antigens / Q000276:immunology*; D006648:Histocompatibility; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000911:Antibodies, Monoclonal; D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006684:HLA-DR Antigens; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D003404:Creatinine
keywords: Hazard risk; Human leukocyte antigen; Lung transplantation; Mismatch; Mortality; Survival