Background:

Whether HLA-mismatch is associated with higher rates of antibody-mediated rejection (AMR) after heart transplantation (HTx), and whether Class I and Class II antigens have a differential effect on outcome, is unknown.

Methods:

The records of patients transplanted at the UTAH Cardiac Transplant Program between 1992 and 2011 were reviewed. The association of HLA-mismatch at major antigen class I loci HLA-A and HLA-B, and class II loci HLA-DR and HLA-DQ and AMR was analyzed using the Cox proportional hazards regression model. We evaluated the incidence of AMR as determined by the occurrence of pAMR≥2 diagnosed in ≥ 3 episodes.

Results:

Four hundred and fifty one patients met our inclusion criteria, 77% were male, age 45±19 years. There was no significant difference in the incidence of AMR in patients with HLA class I mismatch. However, HLA-DR and HLA-DQ mismatches showed significant association with the incidence of AMR. Absence of HLA-DR and HLA-DQ mismatch appeared to have a strong protective effect against AMR (table). The differences persisted even after adjustment in a multivariable model that included all four studied class I and class II antigen groups.

Conclusion:

Mismatch at the HLA-DR and HLA-DQ loci appears to be associated with increased incidence of AMR after HTx. As advances in ex-vivo organ perfusion may soon allow for extension of the time between organ procurement and HTx, HLA matching in HTx could become possible. Our data indicate matching for Class II antigens could result in reduced incidence of AMR.

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