Patrick M Sullivan1, Paul Warner2, Mariska S Kemna3, Erin L Albers3, Sabrina P Law4, Noel S Weiss5, Yuk M Law3. 1. Division of Pediatric Cardiology, Children's Hospital Los Angeles, Los Angeles, California. Electronic address: Patrick.morris.sullivan@gmail.com. 2. Immunogenetics/HLA Laboratory, Puget Sound Blood Center, Seattle, Washington. 3. Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington. 4. Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, New York, New York. 5. Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington.
Abstract
BACKGROUND: Although evidence links HLA allele mismatching to worse outcomes in pediatric heart transplantation, no studies to our knowledge have applied the quantification of structural HLA differences between donor and recipient to risk evaluation. We examine the association between molecular-level HLA mismatching and long-term graft loss in pediatric recipients of heart transplants. METHODS: HLA Matchmaker was used to quantify the number of mismatched class-specific HLA eplets among 4,851 heart transplant recipients ≤18 years of age in the Scientific Registry of Transplant Recipients (1987-2012). Survival analysis was used to compare long-term probabilities of graft loss by number of eplet mismatches and allele mismatches stratified by eplet mismatches. RESULTS: Recipients with 10 to 20 or >20 class I (HLA-A and HLA-B) eplet mismatches experienced increased long-term graft loss compared with recipients with <10 class I eplet mismatches (adjusted hazard ratio = 1.23 [95% confidence interval = 1.06-1.42], adjusted hazard ratio = 1.27 [95% confidence interval = 1.08-1.50], respectively). Recipients with 2 to 4 class I allele mismatches had increased long-term graft loss compared with recipients with 0 to 1 class I allele mismatches. Neither class II (HLA-DR) eplet mismatching nor class II allele mismatching was associated with graft loss. On stratification by allele and structural eplet mismatching, only recipients with 2 to 4 class I allele mismatches and ≥10 class I eplet mismatches had an increased probability of graft loss compared with recipients with 0 to 1 class I allele mismatches (adjusted hazard ratio = 1.42 [95% confidence interval = 1.09-1.57]). CONCLUSIONS: Molecular-level HLA mismatching may aid in identifying recipients at increased risk of long-term graft loss who could benefit from intensified post-transplant surveillance and management.
BACKGROUND: Although evidence links HLA allele mismatching to worse outcomes in pediatric heart transplantation, no studies to our knowledge have applied the quantification of structural HLA differences between donor and recipient to risk evaluation. We examine the association between molecular-level HLA mismatching and long-term graft loss in pediatric recipients of heart transplants. METHODS: HLA Matchmaker was used to quantify the number of mismatched class-specific HLA eplets among 4,851 heart transplant recipients ≤18 years of age in the Scientific Registry of Transplant Recipients (1987-2012). Survival analysis was used to compare long-term probabilities of graft loss by number of eplet mismatches and allele mismatches stratified by eplet mismatches. RESULTS: Recipients with 10 to 20 or >20 class I (HLA-A and HLA-B) eplet mismatches experienced increased long-term graft loss compared with recipients with <10 class I eplet mismatches (adjusted hazard ratio = 1.23 [95% confidence interval = 1.06-1.42], adjusted hazard ratio = 1.27 [95% confidence interval = 1.08-1.50], respectively). Recipients with 2 to 4 class I allele mismatches had increased long-term graft loss compared with recipients with 0 to 1 class I allele mismatches. Neither class II (HLA-DR) eplet mismatching nor class II allele mismatching was associated with graft loss. On stratification by allele and structural eplet mismatching, only recipients with 2 to 4 class I allele mismatches and ≥10 class I eplet mismatches had an increased probability of graft loss compared with recipients with 0 to 1 class I allele mismatches (adjusted hazard ratio = 1.42 [95% confidence interval = 1.09-1.57]). CONCLUSIONS: Molecular-level HLA mismatching may aid in identifying recipients at increased risk of long-term graft loss who could benefit from intensified post-transplant surveillance and management.
Authors: Johan Nilsson; David Ansari; Mattias Ohlsson; Peter Höglund; Ann-Sofie Liedberg; J Gustav Smith; Pierre Nugues; Bodil Andersson Journal: J Am Heart Assoc Date: 2019-07-24 Impact factor: 5.501
Authors: Emilio Osorio-Jaramillo; Geert W Haasnoot; Alexandra Kaider; Anne-Kristin Schaefer; Thomas Haberl; Johannes Goekler; Philipp Angleitner; Roxana Moayedifar; Andreas Zuckermann; Gottfried F Fischer; Guenther Laufer; Frans H J Claas; Arezu Z Aliabadi-Zuckermann Journal: Transpl Int Date: 2020-06-23 Impact factor: 3.782