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Influence of HLA Mismatching on Survival in Lung Transplantation

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Abstract

Background

Data on human leukocyte antigen (HLA) mismatching and survival after lung transplantation (LTx) are variable.

Methods

The UNOS database was queried from 1987 to 2013 to examine survival associated with total HLA mismatch ≥3 and mismatches of 2 at A, B, and DR loci.

Results

Of 23,528 first-time, adult LTx recipients, 23,384 were included in the univariate Cox analysis, 19,944 in the Kaplan–Meier survival function evaluation, and 16,224 in the multivariate Cox models. Adjusted models found that the total HLA mismatch ≥3 increased the mortality hazard [hazard ratio (HR) 1.214; 95 % confidence interval (95 % CI) 1.073, 1.374; p = 0.002]. Both HLA-A (HR 1.070; 95 % CI 1.023, 1.119; p = 0.003) and HLA-DR (HR 1.053; 95 % CI 1.007, 1.101; p = 0.024) were associated with increased mortality risk, but HLA-B (HR 1.006; 95 % CI 0.958, 1.056; p = 0.805) was not. Older age, higher creatinine, and higher body mass index were associated with increased risk for death. More recent lung transplant and longer ischemic time were associated with reduced mortality risk. Induction with basiliximab at time of transplant was beneficial by significantly decreasing the risk of death (HR 0.846; 95 % CI 0.786, 0.909; p < 0.001).

Conclusions

HLA mismatching is associated with increased hazard risk for death after LTx, while induction with basiliximab and other factors related to LTx reduce the risk.

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Acknowledgments

The authors would like to acknowledge Dmitry Tumin for his statistical expertise in the data analysis.

Author contribution

Don Hayes, Jr.: Conception and design, acquisition of data, interpretation of data, drafting of the manuscript. Bryan A. Whitson: Conception and design, interpretation of data, revision of the manuscript. Samir N. Ghadiali: Interpretation of data, revision of the manuscript. Joseph D. Tobias: Interpretation of data, revision of the manuscript. Heidi M. Mansour: Interpretation of data, revision of the manuscript. Sylvester M. Black: Conception and design, interpretation of data, revision of the manuscript.

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Authors and Affiliations

  1. Section of Pulmonary Medicine, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, 700 Children’s Drive, Columbus, OH, 43205, USA

    Don Hayes Jr.

  2. Department of Internal Medicine, The Ohio State University, Columbus, OH, USA

    Don Hayes Jr. & Samir N. Ghadiali

  3. Department of Surgery, The Ohio State University, Columbus, OH, USA

    Bryan A. Whitson & Sylvester M. Black

  4. Department of Anesthesiology, The Ohio State University, Columbus, OH, USA

    Joseph D. Tobias

  5. Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA

    Samir N. Ghadiali

  6. Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA

    Joseph D. Tobias

  7. Skaggs Pharmaceutical Sciences Center, The University of Arizona College of Pharmacy, Tucson, AZ, USA

    Heidi M. Mansour

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  1. Don Hayes Jr.
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Correspondence to Don Hayes Jr..

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Hayes, D., Whitson, B.A., Ghadiali, S.N. et al. Influence of HLA Mismatching on Survival in Lung Transplantation. Lung 193, 789–797 (2015). https://doi.org/10.1007/s00408-015-9768-9

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  • DOI: https://doi.org/10.1007/s00408-015-9768-9

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