Johan Nilsson, David Ansari, Mattias Ohlsson, Peter Höglund, Ann-Sofie Liedberg, J. Gustav Smith, MD, Pierre Nugues and Bodil Andersson
HLA based risk stratification in heart transplant recipients – implications for targeted surveillance
LU TP 19-34
Abstract:
Background
Donor-recipient human leukocyte antigen (HLA) matching is not routinely performed in heart transplantation. However, novel approaches to allograft perfusion may allow for longer times between allograft procurement and transplant, possibly making advanced HLA matching feasible. The purpose of this study is to reexamine whether HLA mismatch may be used in risk stratification to improve long-term outcomes in heart transplantation.
Methods and results
We analyzed 34,681 recipient undergoing heart transplantation between 1987 and 2013 from the Scientific Registry of Transplant Recipients (SRTR) study group. We quantified the number of HLA eplet mismatches using HLAMatchmaker software. We used Cox regression for analysis of time to graft loss. The adjusted hazard for graft loss due to more than 40 mismatches of HLA-DR/DQ eplet and more than 4 mismatches of HLA-DR/DQ allele varied by recipient age; HR=1.36 (95% CI 1.10-1.69) in <40y, HR=1.13 (95% CI 1.02-1.25) in 40-60y, and HR=0.95 (95% CI 0.81-1.11) in >60y; and HR=1.36 (95% CI 1.10-1.69) in <40y, HR=1.13 (95% CI 1.02-1.25) in 40-60y, and HR=0.95 (95% CI 0.81-1.11) in >60y, respectively. The risk of graft loss was more pronounced after one-year HR=1.32 (95% CI 1.02-1.70), and HR=1.51 (95% CI 1.12-2.03), respectively, in <40y, while HLA eplet mismatch was not associated with graft loss within one-year. Pre-sensitized recipients with panel reactive antibodies (PRA) >10%, on the other hand, had an adjusted HR=1.26 (95% CI 1.15-1.38) for graft loss within one-year but not thereafter. HLA eplet mismatch was independent of PRA regarding prediction of graft loss after one-year.
Conclusions
HLA mismatch may be used in risk stratification for intensified post-transplant surveillance and therapy.
Background
Donor-recipient human leukocyte antigen (HLA) matching is not routinely performed in heart transplantation. However, novel approaches to allograft perfusion may allow for longer times between allograft procurement and transplant, possibly making advanced HLA matching feasible. The purpose of this study is to reexamine whether HLA mismatch may be used in risk stratification to improve long-term outcomes in heart transplantation.
Methods and results
We analyzed 34,681 recipient undergoing heart transplantation between 1987 and 2013 from the Scientific Registry of Transplant Recipients (SRTR) study group. We quantified the number of HLA eplet mismatches using HLAMatchmaker software. We used Cox regression for analysis of time to graft loss. The adjusted hazard for graft loss due to more than 40 mismatches of HLA-DR/DQ eplet and more than 4 mismatches of HLA-DR/DQ allele varied by recipient age; HR=1.36 (95% CI 1.10-1.69) in <40y, HR=1.13 (95% CI 1.02-1.25) in 40-60y, and HR=0.95 (95% CI 0.81-1.11) in >60y; and HR=1.36 (95% CI 1.10-1.69) in <40y, HR=1.13 (95% CI 1.02-1.25) in 40-60y, and HR=0.95 (95% CI 0.81-1.11) in >60y, respectively. The risk of graft loss was more pronounced after one-year HR=1.32 (95% CI 1.02-1.70), and HR=1.51 (95% CI 1.12-2.03), respectively, in <40y, while HLA eplet mismatch was not associated with graft loss within one-year. Pre-sensitized recipients with panel reactive antibodies (PRA) >10%, on the other hand, had an adjusted HR=1.26 (95% CI 1.15-1.38) for graft loss within one-year but not thereafter. HLA eplet mismatch was independent of PRA regarding prediction of graft loss after one-year.
Conclusions
HLA mismatch may be used in risk stratification for intensified post-transplant surveillance and therapy.
LU TP 19-34