The influence of conventional and cross-reactive group HLA matching on cardiac transplant outcome: an analysis from the United Network of Organ Sharing Scientific Registry.
The influence of conventional and cross-reactive group HLA matching on cardiac transplant outcome: an analysis from the United Network of Organ Sharing Scientific Registry.
复制标题
传统和交叉反应组 HLA 匹配对心脏移植结果的影响：来自器官共享科学登记联合网络的分析。
作者：
J. Thompson;L. Thacker;S. Takemoto
背景
较短的耐受性冷缺血时间和其他危险因素的重要性已普遍取代了人类白细胞抗原配型在供心分配中的作用。然而，在进行HLA配型和交叉配型所需的准确性和时间方面的最新进展，使我们重新检查了器官共享移植登记联合网络，以了解与其他可能的危险因素相关的人类白细胞抗原不相容对预后的影响。
方法
这些因素包括传统的人类白细胞抗原A、B和交叉反应组(CREG)不匹配(Mm)、人类白细胞抗原DR mm、移植前群体反应性抗体(PRA)、受者和供者种族和供者年龄、冷缺血时间，以及移植前使用左心室辅助装置或主动脉内球囊反搏。
结果
非白人受者的三年存活率(0.6921)明显低于白人受者(0.7632)，但这种差异不能用供受者之间偶然发生的人类白细胞抗原多发性硬化的程度来解释。然而，多发性骨髓瘤的发生程度似乎对存活率有影响。在多变量分析中，人类白细胞抗原DR mm的重要性得到了确认，在使用辅助设备和受体种族方面，它仅排在第二位。HLA-A和B-mM还会产生额外的影响，但只有白人受者才会出现这种情况。其中，人类白细胞抗原-A作为一个独立的危险因素具有统计学意义。总体而言，CREG mm不是一个重要变量。然而，与0-1或0-2A、B、0 DR mm相比，0-1或0-2 CREG、0 DR mm的移植物存活率是0-1或0-2 A、B、0 DR mm的两倍多，且1年和3年存活率非常好。假设冷缺血时间不变，计算了当器官采购组织的等待名单上有50-100名患者时，可能实现的0 CREG，0 DR mm，ABO相合移植的数量。大约24-36%的出人意料的高频率表明，这种有利的匹配可以与当地分配过程中的其他重要因素一起考虑。当移植前PRA被分析为从0到100%的连续变量时，它是一个非常显著的危险因素，但当PRA以高于零的20%的增量进行分析时，这种影响更加明显。最近，左心室辅助装置的使用变得越来越普遍，这与移植前PRA水平显著升高有关。当它们同时发生时，数据表明这些患者移植失败的风险非常高。
结论
我们认为，新的分型和交叉配型技术使将人类白细胞抗原标准加入到供者心脏器官的分配方案中成为可能，并将导致长期存活率的提高。
BACKGROUND
The short tolerable cold ischemia time and the importance of other risk factors have generally superseded the role of HLA matching in the allocation of donor hearts. Recent advances in the accuracy and time required to perform HLA typing and crossmatching, however, have led us to re-examine the United Network of Organ Sharing Transplant Registry for the effects of the HLA incompatibility on outcome in relation to other possible risk factors.
METHODS
These include conventional HLA-A, -B, and cross-reactive group (CREG) mismatching (mm), HLA-DR mm, pretransplantation panel-reactive antibody (PRA), recipient and donor race and donor age, cold ischemia time, and the pretransplantation use of either a left ventricular assist device or an intra-aortic balloon pump.
RESULTS
Three-year survival was clearly inferior in non-white (0.6921) as compared with white (0.7632) recipients, but this difference could not be accounted for by the degree of donor-recipient HLA mm that had occurred by chance. Nevertheless, the degree of mm that did occur seemed to have an impact on survival. The importance of HLA-DR mm was confirmed, and it ranked only behind the use of an assist device and recipient race in the multivariate analysis. HLA-A and B mm exerted an additional effect, but this was only true in white recipients. Of these, HLA-A achieved statistical significance as an independent risk factor. In general, CREG mm was not a significant variable. However, more than twice as many 0-1 or 0-2 CREG, 0 DR mm as compared with 0-1 or 0-2 A,B, 0 DR mm transplants enjoyed approximately equal and very good 1- and 3-year survival. Assuming no change is cold ischemia time, the potential number of 0 CREG, 0 DR mm, ABO-compatible transplants that could be achieved when an Organ Procurement Organization had 50-100 patients on their waiting list was calculated. The surprisingly high frequency of approximately 24-36% suggests that this favorable match could be considered along with other important factors in the local allocation process. When pretransplantation PRA was analyzed as a continuous variable from 0 to 100%, it was a highly significant risk factor, but this effect was more strikingly evident when the PRA was analyzed in 20% increments above zero. Recently, left ventricular assist device usage has become increasingly common, and it has been associated with strikingly increased pretransplantation PRA levels. When they occur together, the data indicates that these patients are at a very high risk for graft failure.
CONCLUSIONS
We believe that newer typing and crossmatching techniques make it possible to add HLA criteria to the allocation protocol of donor cardiac organs and would lead to improved long-term survival.
移植后头三个月内人心脏同种异体移植物组织相容性和其他危险因素。
影响因子：
6.2
作者：
Zerbe,TR;Arena,VC;Kormos,RL;Griffith,BP;Hardesty,RL;Duquesnoy,RJ
通讯作者：
Duquesnoy,RJ
为当地库和少数群体公平分配 HLA 相容肾脏。
DOI：
10.1056/nejm199409223311202
发表时间：
1994
期刊：
The New England journal of medicine
影响因子：
--
作者：
Takemoto,S;Terasaki,PI;Gjertson,DW;Cecka,JM
通讯作者：
Cecka,JM