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首页> 外文期刊>Hepatology: Official Journal of the American Association for the Study of Liver Diseases >Long-term outcome of human leukocyte antigen mismatching in liver transplantation: results of the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database.
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Long-term outcome of human leukocyte antigen mismatching in liver transplantation: results of the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database.

机译：肝移植中人白细胞抗原错配的长期结果：美国国立糖尿病与消化与肾脏疾病研究所肝移植数据库的结果。

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摘要

A perfect or nearly perfect human leukocyte antigen (HLA) match has been associated with better immediate and long-term survival of diseased donor kidney transplants. However, the effect of HLA matching for hepatic allografts remains poorly defined. Using data from the National Institutes of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database, we investigated the association between HLA mismatches and hepatic allograft survival, disease recurrence, and immunosuppression interactions. A, B, and DR loci were used to calculate total mismatch scores of 0 (no mismatches in any loci) to 6 (mismatches in all loci). Seven hundred ninety-nine adults (male, 55%; female, 45%) underwent 883 liver transplants. The 10-year graft survival according to total mismatch score was as follows: 0-2, 60%; 3-4, 54%; and 5-6, 57%. There was a negative effect of mismatching at the A locus on patient survival, with shorter survival for patients with 1 or 2 mismatches compared with 0 mismatches [P = 0.05, hazard ratio (HR) = 1.6]. Patients on tacrolimus with 1 or 2 mismatches at B or DR loci appeared to have increased rates of patient and graft survival compared to patients with 0 mismatches, with the appearance of a protective effect of tacrolimus (HR = 0.67). The effect of HLA mismatching was more pronounced on certain disease recurrences. DR-locus mismatch increased recurrence of autoimmune hepatitis (P = 0.01, HR = 4.2) and primary biliary cirrhosis (P = 0.04, HR = 2). Mismatch in the A locus was associated with more recurrence of hepatitis C virus (P = 0.01, HR = 1.6) and primary sclerosing cholangitis (P = 0.03, HR = 2.9). CONCLUSION: Mismatching at the A locus decreases patient survival in liver transplant recipients, and mismatching at the DR and A loci affects recurrence of autoimmune liver diseases and hepatitis C, respectively.
机译：完美的或接近完美的人类白细胞抗原（HLA）匹配与患病的供体肾脏移植的更好的即时和长期生存相关。但是，HLA匹配对肝脏同种异体移植物的作用仍然不清楚。使用来自美国国立糖尿病与消化与肾脏疾病研究所肝脏移植数据库的数据，我们研究了HLA错配与肝同种异体移植存活，疾病复发和免疫抑制相互作用之间的关联。使用A，B和DR基因座来计算总错配得分，分数为0（在任何基因座中都没有错配）到6（在所有基因座中都错配）。 799名成年人（男性，占55％;女性，占45％）进行了883次肝移植。根据总失配得分的10年移植物存活率如下：0-2，60％; 3-4，54％; 5-6、57％。 A位点错配对患者生存具有负面影响，错配1或2的患者的生存期短于0错配[P = 0.05，危险比（HR）= 1.6]。他克莫司在B或DR位点错配为1或2个错配的患者与0个错配为0的患者相比，似乎具有更高的患者和移植物存活率，并出现了他克莫司的保护作用（HR = 0.67）。 HLA错配对某些疾病复发的影响更为明显。 DR-基因座不匹配增加了自身免疫性肝炎（P = 0.01，HR = 4.2）和原发性胆汁性肝硬化（P = 0.04，HR = 2）的复发。 A基因座的不匹配与丙型肝炎病毒的复发（P = 0.01，HR = 1.6）和原发性硬化性胆管炎（P = 0.03，HR = 2.9）有关。结论：A位点的错配会降低肝移植受者的患者存活率，而DR位点和A位点的错配会分别影响自身免疫性肝病和丙型肝炎的复发。

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