Type and Extent of HLA Mismatch and Antibody-Mediated Rejection in Heart Transplantation

Abstract

Purpose Advances in ex-vivo organ perfusion may soon allow for extension of the time between organ procurement and heart transplant. However, presently the necessity for short allograft ischemic time in heart transplantation makes human leukocyte antigen (HLA) matching between donors and recipients impractical. Our aim was to investigate whether HLA mismatch is correlated with antibody mediated rejection (AMR) in heart transplantation. Methods and Materials The records of patients transplanted at the UTAH Cardiac Transplant Program between 1992 and 2011 were reviewed. HLA-mismatch at major antigen class I loci HLA-A and HLA-B, and class II loci HLA-DR and HLA-DQ, were analyzed using the Cox proportional hazards regression model. AMR was defined with the occurrence of ≥ 3 AMR episodes. Results Four hundred and fifty one patients met our inclusion criteria, 77% were male and the age was 45±19 years. HLA-DR and DQ have significant association with the incidence of AMR within the first year and at any time ( table ). There was no significant difference in the incidence of antibody mediated rejection (AMR) in patients with HLA class I mismatch. Conclusions HLA-DR and HLA-DQ mismatch appear to be associated with increased incidence of AMR after heart transplant. Prospective HLA class II antigens matching may result in reduced incidence of AMR and better outcome in heart transplantation. [ Figure 1 ]