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Human Leukocyte Antigen‐Based Risk Stratification in Heart Transplant Recipients—Implications for Targeted Surveillance

BACKGROUND: Human leukocyte antigen (HLA) matching isn't routinely performed in heart transplantation. Novel allograft perfusion methods may make HLA matching feasible. The purpose of this study is to reexamine whether HLA mismatch may be used in risk stratification to improve outcomes in heart...

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Autores principales: Nilsson, Johan, Ansari, David, Ohlsson, Mattias, Höglund, Peter, Liedberg, Ann‐Sofie, Smith, J. Gustav, Nugues, Pierre, Andersson, Bodil
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761633/
https://www.ncbi.nlm.nih.gov/pubmed/31339067
http://dx.doi.org/10.1161/JAHA.118.011124
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author Nilsson, Johan
Ansari, David
Ohlsson, Mattias
Höglund, Peter
Liedberg, Ann‐Sofie
Smith, J. Gustav
Nugues, Pierre
Andersson, Bodil
author_facet Nilsson, Johan
Ansari, David
Ohlsson, Mattias
Höglund, Peter
Liedberg, Ann‐Sofie
Smith, J. Gustav
Nugues, Pierre
Andersson, Bodil
author_sort Nilsson, Johan
collection PubMed
description BACKGROUND: Human leukocyte antigen (HLA) matching isn't routinely performed in heart transplantation. Novel allograft perfusion methods may make HLA matching feasible. The purpose of this study is to reexamine whether HLA mismatch may be used in risk stratification to improve outcomes in heart transplantation. METHODS AND RESULTS: We analyzed 34 681 recipients undergoing heart transplantation between 1987 and 2013. We used HLAMatchmaker to quantify HLA eplet mismatches and Cox regression for analysis of time to graft loss. Recipients with 4 mismatched HLA‐DR/DQ alleles and >40 eplets reached an adjusted hazard ratio (HR) for graft loss of 1.17 (95% CI 1.07–1.28) and 1.11 (95% CI 1.03–1.21), respectively. We found significant interaction between recipient age and numbers of HLA‐DR/DQ allele and eplet mismatches resulting in an adjusted HR of 1.78 (95% 1.13–2.80) and 1.82 (95% CI, 1.23–2.70), respectively. HR for both interaction terms was 0.99 (95% CI, 0.98–1.00). Risk of graft loss was more pronounced after 1 year, where recipient <40 years with 4 mismatched HLA‐DR/DQ alleles and >40 eplets had an adjusted HR of 1.51 (95% CI 1.12–2.03) and 1.32 (95% CI 1.02–1.70), respectively. Pre‐sensitized recipients with panel reactive antibodies >10% had an adjusted HR=1.27 (95% CI 1.16–1.40) for graft loss within 1 year but not thereafter. HLA eplet mismatch was independent of panel reactive antibodies on reduction of graft loss within and after 1 year, P (interaction)=0.888 and 0.389. CONCLUSIONS: HLA mismatch may be used in risk stratification for intensified post‐transplant surveillance and therapy.
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spelling pubmed-67616332019-09-30 Human Leukocyte Antigen‐Based Risk Stratification in Heart Transplant Recipients—Implications for Targeted Surveillance Nilsson, Johan Ansari, David Ohlsson, Mattias Höglund, Peter Liedberg, Ann‐Sofie Smith, J. Gustav Nugues, Pierre Andersson, Bodil J Am Heart Assoc Original Research BACKGROUND: Human leukocyte antigen (HLA) matching isn't routinely performed in heart transplantation. Novel allograft perfusion methods may make HLA matching feasible. The purpose of this study is to reexamine whether HLA mismatch may be used in risk stratification to improve outcomes in heart transplantation. METHODS AND RESULTS: We analyzed 34 681 recipients undergoing heart transplantation between 1987 and 2013. We used HLAMatchmaker to quantify HLA eplet mismatches and Cox regression for analysis of time to graft loss. Recipients with 4 mismatched HLA‐DR/DQ alleles and >40 eplets reached an adjusted hazard ratio (HR) for graft loss of 1.17 (95% CI 1.07–1.28) and 1.11 (95% CI 1.03–1.21), respectively. We found significant interaction between recipient age and numbers of HLA‐DR/DQ allele and eplet mismatches resulting in an adjusted HR of 1.78 (95% 1.13–2.80) and 1.82 (95% CI, 1.23–2.70), respectively. HR for both interaction terms was 0.99 (95% CI, 0.98–1.00). Risk of graft loss was more pronounced after 1 year, where recipient <40 years with 4 mismatched HLA‐DR/DQ alleles and >40 eplets had an adjusted HR of 1.51 (95% CI 1.12–2.03) and 1.32 (95% CI 1.02–1.70), respectively. Pre‐sensitized recipients with panel reactive antibodies >10% had an adjusted HR=1.27 (95% CI 1.16–1.40) for graft loss within 1 year but not thereafter. HLA eplet mismatch was independent of panel reactive antibodies on reduction of graft loss within and after 1 year, P (interaction)=0.888 and 0.389. CONCLUSIONS: HLA mismatch may be used in risk stratification for intensified post‐transplant surveillance and therapy. John Wiley and Sons Inc. 2019-07-24 /pmc/articles/PMC6761633/ /pubmed/31339067 http://dx.doi.org/10.1161/JAHA.118.011124 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Nilsson, Johan
Ansari, David
Ohlsson, Mattias
Höglund, Peter
Liedberg, Ann‐Sofie
Smith, J. Gustav
Nugues, Pierre
Andersson, Bodil
Human Leukocyte Antigen‐Based Risk Stratification in Heart Transplant Recipients—Implications for Targeted Surveillance
title Human Leukocyte Antigen‐Based Risk Stratification in Heart Transplant Recipients—Implications for Targeted Surveillance
title_full Human Leukocyte Antigen‐Based Risk Stratification in Heart Transplant Recipients—Implications for Targeted Surveillance
title_fullStr Human Leukocyte Antigen‐Based Risk Stratification in Heart Transplant Recipients—Implications for Targeted Surveillance
title_full_unstemmed Human Leukocyte Antigen‐Based Risk Stratification in Heart Transplant Recipients—Implications for Targeted Surveillance
title_short Human Leukocyte Antigen‐Based Risk Stratification in Heart Transplant Recipients—Implications for Targeted Surveillance
title_sort human leukocyte antigen‐based risk stratification in heart transplant recipients—implications for targeted surveillance
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761633/
https://www.ncbi.nlm.nih.gov/pubmed/31339067
http://dx.doi.org/10.1161/JAHA.118.011124
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