The impact of HLA-DR mismatch status on retransplant-free survival and bronchiolitis obliterans syndrome‒free survival among sensitized lung transplant recipients

https://doi.org/10.1016/j.healun.2020.09.016Get rights and content

INTRODUCTION

Donor‒recipient HLA-DR locus matching may be protective against bronchiolitis obliterans syndrome (BOS) in lung transplant recipients. It is unknown whether this benefit is more significant among sensitized (calculated panel reactive antibodies (CPRAs) of >0%) and highly sensitized (CPRAs of ≥80%) recipients who may be at a higher risk for BOS.

METHODS

This was a retrospective cohort study of adults in the Scientific Registry of Transplant Recipients who underwent lung transplantation between May 5, 2005 and May 31, 2019. Retransplant-free survival and BOS-free survival were compared among recipients with 0 vs ≥1 DR mismatches, grouped according to sensitization.

RESULTS

Among all 20,355 included recipients, 0 DR mismatch status was associated with improved retransplant-free survival (hazard ratio [HR] = 0.83, 95% CI = 0.74–0.93, p = 0.002) and BOS-free survival (HR = 0.86, 95% CI = 0.77–0.96, p = 0.007). Among sensitized recipients, 0 DR mismatch status was also associated with improved retransplant-free survival (HR = 0.79, 95% CI = 0.65–0.97, p = 0.02) and BOS-free survival (HR = 0.82, 95% CI = 0.67–1.00, p = 0.04). There was however no difference in retransplant-free or BOS-free survival between sensitized and non-sensitized recipients with 0 DR mismatches. Among highly sensitized recipients, 0 DR mismatch status was not associated with retransplant-free or BOS-free survival. Among sensitized and highly sensitized recipients, 0 DR mismatch status was not associated with reduced use of plasmapheresis or reduced biopsy-proven, treated acute cellular rejection compared with non-sensitized recipients.

CONCLUSIONS

HLA-DR matching is associated with a similar improvement in retransplant-free and BOS-free survival among non-sensitized and sensitized lung transplant recipients. DR matching does not confer a more substantial retransplant-free or BOS-free survival benefit to highly sensitized recipients than to non-sensitized recipients.

Section snippets

Study design

This study used data from the Scientific Registry of Transplant Recipients (SRTR). The SRTR data system includes data on all donors, wait-listed candidates, and transplant recipients in the United States (US), submitted by the members of the Organ Procurement and Transplantation Network. The Health Resources and Services Administration of the US Department of Health and Human Services provides oversight to the activities of the Organ Procurement and Transplantation Network and SRTR contractors.

Study cohort

Among the 24,891 adult recipients who underwent first transplantation in the study years, 2,121 (10.4%) were excluded for having no CPRA data, and 2,415 (9.7%) were excluded for having no DR data, leaving 20,355 recipients in the final study cohort. A total of 7,259 recipients (35.7%) were sensitized (CPRA of >0%), and 526 (2.6%) were highly sensitized (CPRA of ≥80%). Both sensitized and highly sensitized recipients were more likely to be female, to be non-White, to have had prior pregnancies,

Discussion

Previous studies have suggested that donor‒recipient HLA-DR locus matching may be protective against BOS in lung transplant recipients, but it is unknown whether this benefit is more pronounced for sensitized and highly sensitized recipients. Our primary findings were that first, although 0 donor‒recipient HLA-DR mismatches are associated with improved retransplant-free survival and BOS1-free and BOS3-free survival among all lung transplant recipients, this effect is not more pronounced in

Conclusions

HLA-DR matching does not offer an added benefit with regard to retransplant-free or BOS-free survival for sensitized lung transplant recipients compared with non-sensitized recipients. HLA-DR matching is not associated with improved retransplant-free or BOS-free survival or relevant rejection-related outcomes among highly sensitized recipients.

Disclosure statement

The authors have no conflicts of interest to disclose.

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