HLA mismatching affects disease recurrence but not survival after liver transplantation

    Balan V et al. (2008) 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. Hepatology 48: 878–888

    Human leukocyte antigen (HLA) matching improves survival after kidney transplantation, but it is not known whether matching affects outcomes after liver transplantation. Balan et al. used data from the National Institutes of Diabetes and Digestive and Kidney Diseases Liver Transplant database to assess the relationship between degree of HLA mismatching at the A, B and DR loci and long-term outcome in 799 liver transplant recipients.

    The total number of HLA mismatches at all three loci did not predict 5-year or 10-year graft or patient survival. HLA-A mismatching decreased patient and graft survival (P = 0.05 and P = 0.10, respectively), but neither HLA-B or HLA-DR mismatching had an effect on survival outcomes. In patients with underlying autoimmune hepatitis, a high total number of mismatches increased disease recurrence (hazard ratio [HR] 2.4; P = 0.01), but also had positive effects on graft survival. HLA-DR mismatching increased disease recurrence in individuals with primary biliary cirrhosis (HR 2.0; P = 0.04), whereas mismatching at the A locus increased recurrence in those with primary sclerosing cholangitis (HR 3.0; P = 0.02) or hepatitis C (HR 1.6; P = 0.01).

    Although the total number of HLA mismatches does not seem to affect patient or graft survival in liver transplant recipients, mismatches at particular loci affect the chance of disease recurrence according to type of underlying liver disease. The authors recommend that donor–recipient HLA profile should, therefore, be used to tailor the level of immunosuppression.

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    HLA mismatching affects disease recurrence but not survival after liver transplantation. Nat Rev Gastroenterol Hepatol 5, 658 (2008). https://doi.org/10.1038/ncpgasthep1293

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