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. 1988 Sep;46(3):372-7.

Histocompatibility and liver transplant outcome. Does HLA exert a dualistic effect?

B H Markus  1 , R J Duquesnoy, R D Gordon, J J Fung, M Vanek, G Klintmalm, C Bryan, D Van Thiel, T E Starzl
Affiliations

Histocompatibility and liver transplant outcome. Does HLA exert a dualistic effect?

B H Markus et al. Transplantation. 1988 Sep.

Abstract

An analysis of more than 500 liver transplants has demonstrated that HLA compatibility is associated with diminished allograft survival. Liver transplants with zero mismatches for class I and/or class II HLA antigens have shown significantly lower actuarial survival rates than transplants with one or more mismatches for these loci. In a group of 119 failed liver allografts from patients undergoing retransplantation, a higher incidence of failure due to rejection correlated with a lower degree of HLA compatibility especially for HLA-DR. In contrast, the incidence of liver transplant failures due to primary nonfunction was relatively higher with HLA-DR compatible transplants. Considering the role of HLA as a restriction element in cellular interactions during the immune response, these findings suggest that HLA compatibility may have a dualistic effect on liver transplant outcome. On one hand, HLA compatibility reduced transplant rejection--and on the other hand, it may enhance other immunological mechanisms leading to allograft dysfunction, particularly in patients at risk of developing recurrent autoimmune diseases or infection.

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Figures

Figure 1
Figure 1
Actuarial survival of 574 liver transplants with different degrees of HLA-A incompatibility. The differences between the zero versus one and two mismatches for HLA-A were statistically significant as determined by Breslow analysis (early events): P=0.057; and by Mantel-Cox analysis (late events): P=0.029.
Figure 2
Figure 2
Actuarial survival of 507 liver transplants with different degrees of HLA-DR incompatibility. The group of zero HLA-DR mismatches showed significantly lower survival rates than transplants with one and two HLA-DR mismatches (Breslow: P=0.054; Mantel-Cox: P=0.087).
Figure 3
Figure 3
In 507 transplants with complete typing information for all HLA-A, B, and DR loci, 91 patients were identified for whom there was a zero mismatch for at leaat one of these loci. Highly significant lower survival rates were observed with this group as compared with the remaining group of 416 patients receiving tranaplants without zero mismatches at any of the HLA-A, B, or DR loci (Breslow: P=0.008; Mantel-Cox: P=0.008).
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References

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