Human Leukocyte Antigen-Based Risk Stratification in Heart Transplant Recipients-Implications for Targeted Surveillance
(2019) In Journal of the American Heart Association 8(15).- Abstract
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... (More)
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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- author
- Nilsson, Johan LU ; Ansari, David LU ; Ohlsson, Mattias LU ; Höglund, Peter LU ; Liedberg, Ann Sofie LU ; Smith, J. Gustav LU ; Nugues, Pierre LU and Andersson, Bodil LU
- organization
-
- Robotics and Semantic Systems
- Thoracic Surgery
- Artificial Intelligence and Bioinformatics in Cardiothoracic Sciences (AIBCTS) (research group)
- eSSENCE: The e-Science Collaboration
- Heart and Lung transplantation (research group)
- Artificial Intelligence in CardioThoracic Sciences (AICTS) (research group)
- Computational Biology and Biological Physics - Has been reorganised
- Division of Clinical Chemistry and Pharmacology
- Division of Microbiology, Immunology and Glycobiology - MIG
- Heart Failure and Mechanical Support (research group)
- Cardiology
- EpiHealth: Epidemiology for Health
- EXODIAB: Excellence of Diabetes Research in Sweden
- Department of Computer Science
- ELLIIT: the Linköping-Lund initiative on IT and mobile communication
- Surgery (Lund)
- publishing date
- 2019-08-06
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- HLAMatchmaker, human leukocyte antigen, rejection, risk stratification, survival, transplantation
- in
- Journal of the American Heart Association
- volume
- 8
- issue
- 15
- article number
- e011124
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85070483174
- pmid:31339067
- ISSN
- 2047-9980
- DOI
- 10.1161/JAHA.118.011124
- language
- English
- LU publication?
- yes
- id
- e2550f48-1518-46ca-a1ab-b9ad05f4b47d
- date added to LUP
- 2019-08-30 13:52:37
- date last changed
- 2024-04-30 19:39:04
@article{e2550f48-1518-46ca-a1ab-b9ad05f4b47d, abstract = {{<p>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.</p>}}, author = {{Nilsson, Johan and Ansari, David and Ohlsson, Mattias and Höglund, Peter and Liedberg, Ann Sofie and Smith, J. Gustav and Nugues, Pierre and Andersson, Bodil}}, issn = {{2047-9980}}, keywords = {{HLAMatchmaker; human leukocyte antigen; rejection; risk stratification; survival; transplantation}}, language = {{eng}}, month = {{08}}, number = {{15}}, publisher = {{Wiley-Blackwell}}, series = {{Journal of the American Heart Association}}, title = {{Human Leukocyte Antigen-Based Risk Stratification in Heart Transplant Recipients-Implications for Targeted Surveillance}}, url = {{http://dx.doi.org/10.1161/JAHA.118.011124}}, doi = {{10.1161/JAHA.118.011124}}, volume = {{8}}, year = {{2019}}, }