title: Human leukocyte antigen mismatching and survival after lung transplantation in adult and pediatric patients with cystic fibrosis.
abstract: BACKGROUND
  The influence of human leukocyte antigen (HLA) mismatching on survival in adult and pediatric patients with cystic fibrosis (CF) after lung transplantation (LTx) is unknown.
  
  
  METHODS
  The United Network for Organ Sharing database was queried from 1987 to 2013 to determine the influence of HLA mismatching on survival in adult and pediatric CF LTx recipients by assessing the association of HLA mismatching with survival in first-time adult (aged ≥ 18 years) and pediatric (aged <18 years) recipients.
  
  
  RESULTS
  Of 3149 adult and 489 pediatric patients with CF, 3145 and 489 were used for univariate Cox analysis, 2687 and 363 for Kaplan-Meier survival analysis, and 2073 and 257 for multivariate Cox analysis, respectively. Univariate analyses in adult and pediatric patients with CF demonstrated conflicting associations between HLA mismatching and survival (adult hazard ratio [HR], 1.0; 95% confidence interval [CI], 0.97-1.1; P = .45 vs pediatric HR, 0.87; 95% CI, 0.77-0.99; P = .032). Multivariate Cox models including both pediatric and adult patients confirmed that HLA mismatching had an initially protective effect at young ages (HR, 0.85; 95% CI, 0.73-0.99; P = .044) and that this protective effect diminished at older ages and was no longer associated with survival at P < .05 beyond age 10 years.
  
  
  CONCLUSIONS
  HLA mismatching has significantly different implications for survival after LTx in adult compared with pediatric patients with CF.
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio. Electronic address: hayes.705@osu.edu.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Host Defense Program, Nationwide Children's Hospital, Columbus, Ohio; Section of Hematology/Oncology and Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, Ohio; Section of Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Jeffery J
authors.initials: JJ
authors.lastname: Auletta
authors.affiliation: Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Whitson
authors.affiliation: Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Sylvester M
authors.initials: SM
authors.lastname: Black
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kirkby
authors.affiliation: Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio; Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
authors.affiliation: Skaggs Pharmaceutical Sciences Center, The University of Arizona College of Pharmacy, Tucson, Ariz.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Mansour
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006085:Graft Survival; D006680:HLA Antigens; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006680:HLA Antigens
keywords: cystic fibrosis; human leukocyte antigen mismatch; lung transplantation; survival