HLA compatibility and liver transplant outcome. Improved patient survival by HLA and cross-matching

A. Nikaein, L. Backman, L. Jennings, M. F. Levy, R. Goldstein, T. Gonwa, M. J. Stone, G. Klintmalm

Research output: Contribution to journalArticle

108 Citations (Scopus)

Abstract

In liver transplantation (LTx), numerous studies have failed to demonstrate an adverse effect of HLA-A,B,DR incompatibility or of donor- specific positive cross-match on survival of the recipients. In this study, we examined the effect of antidonor cytotoxic antibody and HLA compatibility in 800 LTx recipients with CsA-based immunosuppression. Thirty-four of 482 (7%) recipients were transplanted across a positive donor-specific T cell cross-match. Four-year patient and graft survival was 71% and 67%, respectively, in negative cross-match recipients and 53% and 50%, respectively, in positive cross-match recipients (P=0.0051 and P=0.023). Neither B cell-positive cross-match nor the presence of panel reactive antibody (PRA) had an adverse impact on the liver allograft outcome. Interestingly, 21/58 (36.2%) patients with PRA ≥ 10% had a positive T cell cross-match, whereas only 7/382 (1.8%) patients with PRA < 10% did (P<0.0001). This indicates the predictive value of PRA cross-match results. B lymphocyte cross-match results also were strongly correlated with the presence of PRA, as 26/57 (45.6%) of the patients with PRA ≥ 10% had a positive cross-match, whereas only 22/394 (5.6%) with PRA < 10% did (P<0.0001). Analysis of HLA compatibility demonstrated a significant impact on patient's survival, comparing only 0-2 vs. 6 HLA-A+B+DR mismatches and 0 vs. 1 vs. 2 HLA-DR mismatches. Four-year patient survival rate for 0 to 2 antigen mismatches was 86%, whereas for 6 antigen mismatches it was 62% (P=0.025). Overall actuarial 4-year patient survival rate in HLA-DR- mismatched groups (0 vs. 1 vs. 2) was 84%, 73%, and 64%, respectively (P=0.033). In no mismatched category was graft survival rate significantly different. Sepsis or rejection was the cause of graft loss in 1/10 (10%), 21/75 (28%), and 34/85 (40%) patients with 0, 1, and 2 HLA-DR mismatches, respectively. The difference between patient and graft survival was accounted for by survival after retransplantation, which was lower in patients with more HLA-DR mismatches in primary transplants. The latter group received intensive immunosuppressive therapy during the first month after primary transplantation, as compared with those with fewer HLA-DR mismatches (P=0.04). The above data suggest that prospective cross-match should be performed in patients with ≥ 10% PRA if it is logistically feasible. Alternatively, special immunosuppressive therapy strategies may be applied to LTx recipients having HLA incompatibility with donors (either in cross-match or HLA mismatching) in order to improve the survival rates.

Original languageEnglish (US)
Pages (from-to)786-792
Number of pages7
JournalTransplantation
Volume58
Issue number7
StatePublished - 1994
Externally publishedYes

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Transplants
Survival
Liver
HLA-DR Antigens
Antibodies
Graft Survival
Survival Rate
HLA-A Antigens
HLA-B Antigens
Tissue Donors
Immunosuppressive Agents
B-Lymphocytes
T-Lymphocytes
Antigens
Liver Transplantation
Immunosuppression
Allografts
Sepsis
Transplantation
Therapeutics

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Nikaein, A., Backman, L., Jennings, L., Levy, M. F., Goldstein, R., Gonwa, T., ... Klintmalm, G. (1994). HLA compatibility and liver transplant outcome. Improved patient survival by HLA and cross-matching. Transplantation, 58(7), 786-792.

HLA compatibility and liver transplant outcome. Improved patient survival by HLA and cross-matching. / Nikaein, A.; Backman, L.; Jennings, L.; Levy, M. F.; Goldstein, R.; Gonwa, T.; Stone, M. J.; Klintmalm, G.

In: Transplantation, Vol. 58, No. 7, 1994, p. 786-792.

Research output: Contribution to journalArticle

Nikaein, A, Backman, L, Jennings, L, Levy, MF, Goldstein, R, Gonwa, T, Stone, MJ & Klintmalm, G 1994, 'HLA compatibility and liver transplant outcome. Improved patient survival by HLA and cross-matching', Transplantation, vol. 58, no. 7, pp. 786-792.
Nikaein A, Backman L, Jennings L, Levy MF, Goldstein R, Gonwa T et al. HLA compatibility and liver transplant outcome. Improved patient survival by HLA and cross-matching. Transplantation. 1994;58(7):786-792.
Nikaein, A. ; Backman, L. ; Jennings, L. ; Levy, M. F. ; Goldstein, R. ; Gonwa, T. ; Stone, M. J. ; Klintmalm, G. / HLA compatibility and liver transplant outcome. Improved patient survival by HLA and cross-matching. In: Transplantation. 1994 ; Vol. 58, No. 7. pp. 786-792.
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abstract = "In liver transplantation (LTx), numerous studies have failed to demonstrate an adverse effect of HLA-A,B,DR incompatibility or of donor- specific positive cross-match on survival of the recipients. In this study, we examined the effect of antidonor cytotoxic antibody and HLA compatibility in 800 LTx recipients with CsA-based immunosuppression. Thirty-four of 482 (7{\%}) recipients were transplanted across a positive donor-specific T cell cross-match. Four-year patient and graft survival was 71{\%} and 67{\%}, respectively, in negative cross-match recipients and 53{\%} and 50{\%}, respectively, in positive cross-match recipients (P=0.0051 and P=0.023). Neither B cell-positive cross-match nor the presence of panel reactive antibody (PRA) had an adverse impact on the liver allograft outcome. Interestingly, 21/58 (36.2{\%}) patients with PRA ≥ 10{\%} had a positive T cell cross-match, whereas only 7/382 (1.8{\%}) patients with PRA < 10{\%} did (P<0.0001). This indicates the predictive value of PRA cross-match results. B lymphocyte cross-match results also were strongly correlated with the presence of PRA, as 26/57 (45.6{\%}) of the patients with PRA ≥ 10{\%} had a positive cross-match, whereas only 22/394 (5.6{\%}) with PRA < 10{\%} did (P<0.0001). Analysis of HLA compatibility demonstrated a significant impact on patient's survival, comparing only 0-2 vs. 6 HLA-A+B+DR mismatches and 0 vs. 1 vs. 2 HLA-DR mismatches. Four-year patient survival rate for 0 to 2 antigen mismatches was 86{\%}, whereas for 6 antigen mismatches it was 62{\%} (P=0.025). Overall actuarial 4-year patient survival rate in HLA-DR- mismatched groups (0 vs. 1 vs. 2) was 84{\%}, 73{\%}, and 64{\%}, respectively (P=0.033). In no mismatched category was graft survival rate significantly different. Sepsis or rejection was the cause of graft loss in 1/10 (10{\%}), 21/75 (28{\%}), and 34/85 (40{\%}) patients with 0, 1, and 2 HLA-DR mismatches, respectively. The difference between patient and graft survival was accounted for by survival after retransplantation, which was lower in patients with more HLA-DR mismatches in primary transplants. The latter group received intensive immunosuppressive therapy during the first month after primary transplantation, as compared with those with fewer HLA-DR mismatches (P=0.04). The above data suggest that prospective cross-match should be performed in patients with ≥ 10{\%} PRA if it is logistically feasible. Alternatively, special immunosuppressive therapy strategies may be applied to LTx recipients having HLA incompatibility with donors (either in cross-match or HLA mismatching) in order to improve the survival rates.",
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AU - Backman, L.

AU - Jennings, L.

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AU - Goldstein, R.

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AU - Stone, M. J.

AU - Klintmalm, G.

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N2 - In liver transplantation (LTx), numerous studies have failed to demonstrate an adverse effect of HLA-A,B,DR incompatibility or of donor- specific positive cross-match on survival of the recipients. In this study, we examined the effect of antidonor cytotoxic antibody and HLA compatibility in 800 LTx recipients with CsA-based immunosuppression. Thirty-four of 482 (7%) recipients were transplanted across a positive donor-specific T cell cross-match. Four-year patient and graft survival was 71% and 67%, respectively, in negative cross-match recipients and 53% and 50%, respectively, in positive cross-match recipients (P=0.0051 and P=0.023). Neither B cell-positive cross-match nor the presence of panel reactive antibody (PRA) had an adverse impact on the liver allograft outcome. Interestingly, 21/58 (36.2%) patients with PRA ≥ 10% had a positive T cell cross-match, whereas only 7/382 (1.8%) patients with PRA < 10% did (P<0.0001). This indicates the predictive value of PRA cross-match results. B lymphocyte cross-match results also were strongly correlated with the presence of PRA, as 26/57 (45.6%) of the patients with PRA ≥ 10% had a positive cross-match, whereas only 22/394 (5.6%) with PRA < 10% did (P<0.0001). Analysis of HLA compatibility demonstrated a significant impact on patient's survival, comparing only 0-2 vs. 6 HLA-A+B+DR mismatches and 0 vs. 1 vs. 2 HLA-DR mismatches. Four-year patient survival rate for 0 to 2 antigen mismatches was 86%, whereas for 6 antigen mismatches it was 62% (P=0.025). Overall actuarial 4-year patient survival rate in HLA-DR- mismatched groups (0 vs. 1 vs. 2) was 84%, 73%, and 64%, respectively (P=0.033). In no mismatched category was graft survival rate significantly different. Sepsis or rejection was the cause of graft loss in 1/10 (10%), 21/75 (28%), and 34/85 (40%) patients with 0, 1, and 2 HLA-DR mismatches, respectively. The difference between patient and graft survival was accounted for by survival after retransplantation, which was lower in patients with more HLA-DR mismatches in primary transplants. The latter group received intensive immunosuppressive therapy during the first month after primary transplantation, as compared with those with fewer HLA-DR mismatches (P=0.04). The above data suggest that prospective cross-match should be performed in patients with ≥ 10% PRA if it is logistically feasible. Alternatively, special immunosuppressive therapy strategies may be applied to LTx recipients having HLA incompatibility with donors (either in cross-match or HLA mismatching) in order to improve the survival rates.

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