HLA mismatches influence lung transplant recipient survival, XXXX and rejection: implications for donor lung allocation.

@entity1 @entity697 @entity30626 @entity2149 @entity4154
BACKGROUND: Human leukocyte antigen (HLA) histocompatibility is not considered when placing donor allografts for lung transplantation. We previously reported that fewer individual Class I ( @entity2149 ) antigen mismatches (MM) correlated with improved survival in lung transplant recipients. In this study we evaluated whether the effects of total HLA, Class I and Class II MM were more important determinants of: (1) recipient survival; (2) development of @entity4154 ( @entity4154 ); and (3) freedom from @entity697 ( @entity697 ). METHODS: All adult primary cadaveric lung recipients transplanted between April 1, 1994, and June 30, 2004 entered in the @entity30626 database were included (n = 9,791). Groups were created based on the total number of HLA, Class I and Class II MM. Recipient survival, freedom from @entity697 and freedom from @entity4154 were compared. Univariate data were computed using the Kaplan-Meier method and compared by log-rank test. Multivariate analysis was performed using the Cox proportional hazards method. RESULTS: Univariate analysis identified significantly improved survival in recipients with fewer total HLA (p < 0.001) and Class I MM (p = 0.005). The incidence of @entity4154 was significantly lower in @entity1 with fewer total Class I MM (p = 0.036). @entity697 was influenced only by Class II MM (p = 0.005). By multivariate analysis, total HLA, Class I and Class II MM impacted recipient survival. Total HLA and Class I MM correlated with development of @entity4154 . Class II MM correlated with development of @entity697 . CONCLUSION: HLA MM are important determinants of lung transplant survival, @entity4154 and @entity697 . These data suggest that donor-recipient HLA MM may warrant consideration when allocating organs for lung transplantation.
