The effect of donor characteristics on survival after unrelated donor transplantation for hematologic malignancy
The effect of donor characteristics on survival after unrelated donor transplantation for hematologic malignancy
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DOI：
10.1182/blood-2015-08-663823
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发表时间：
2016-01-14
期刊：
影响因子：
20.3
通讯作者：
Eapen, Mary
中科院分区：
文献类型：
--
作者：
Kollman, Craig;Spellman, Stephen R.;Eapen, Mary
有超过2400万注册的成年供体，非亲属供体移植的数量正在增加。尚未确定在HLA匹配的潜在供体中进行优先排序的最佳策略。因此，当前分析的目的是研究供体特征（年龄、性别、产次、巨细胞病毒血清状态、HLA匹配和血型ABO匹配）与恶性血液病移植后生存率之间的关系。使用logistic或考克斯回归模型检查供体特征与移植结局的相关性，调整与2个独立数据集结局相关的患者疾病和移植特征：1988年至2006年（N = 6349;训练队列）和2007年至2011年（N = 4690;验证队列）。所有供受体对均具有HLA-A、-B、-C和-DRB 1等位基因水平的HLA分型，这是目前选择供体的标准。根据患者疾病和移植特点进行调整后，HLA匹配的年轻供体（18-32岁）移植后的存活率更高（P <0.001）。这些发现在2007年至2011年之间发生的移植中得到了验证。供体年龄每增加10岁，总体死亡率的风险比增加5.5%。HLA差异的增加也与生存恶化相关。供者年龄和供者-受者HLA匹配在选择成人无关供者时很重要。其他供体特征如性别、产次和巨细胞病毒血清状态与存活率无关。ABO配型对生存率的影响是适度的，在提供明确的建议之前必须进一步研究。
There are >24 million registered adult donors, and the numbers of unrelated donor transplantations are increasing. The optimal strategy for prioritizing among comparably HLA-matched potential donors has not been established. Therefore, the objective of the current analyses was to study the association between donor characteristics (age, sex, parity, cytomegalovirus serostatus, HLA match, and blood group ABO match) and survival after transplantation for hematologic malignancy. The association of donor characteristics with transplantation outcomes was examined using either logistic or Cox regression models, adjusting for patient disease and transplantation characteristics associated with outcomes in 2 independent datasets: 1988 to 2006 (N = 6349; training cohort) and 2007 to 2011 (N = 4690; validation cohort). All donor-recipient pairs had allele-level HLA typing at HLA-A, -B, -C, and -DRB1, which is the current standard for selecting donors. Adjusting for patient disease and transplantation characteristics, survival was better after transplantation of grafts from young donors (aged 18-32 years) who were HLA matched to recipients (P < .001). These findings were validated for transplantations that occurred between 2007 and 2011. For every 10-year increment in donor age, there is a 5.5% increase in the hazard ratio for overall mortality. Increasing HLA disparity was also associated with worsening survival. Donor age and donor-recipient HLA match are important when selecting adult unrelated donors. Other donor characteristics such as sex, parity, and cytomegalovirus serostatus were not associated with survival. The effect of ABO matching on survival is modest and must be studied further before definitive recommendations can be offered.