Compatibility index: does this apply to patients following a heart transplant?

Czech version

Authors: H. Bedáňová; J. Ondrášek; J. Černý; P. Němec
Published in: Kardiol Rev Int Med 2011, 13(1): 48-51
Category: From Heart Failure to Heart Transplantation

Overview

Based on the Compatibility Index, routinely used in renal transplants, we attempted to identify those patients who had just had a heart transplant for whom a number of agreements in the HLA system meant that they could be receptive to lower doses of immunosuppressants. We carried out a retrospective analysis of 182 consecutive patients who had received transplants in the Centre of Cardiovascular and Transplantation Surgery in Brno from January 2001 to April 2010. According to their Compatibility Index, patients were arbitrarily divided into Group A (83 patients) with Compatibility Index 0–17 and Group B (99 patients) with Compatibility Index 18–26. We recorded a significantly lower incidence of step 2 acute cellular rejection in group A (p ≤ 0,05), with the incidence of level 3 being the same in both groups. There were no significant differences in rates of infections, nor in the malignancy rate, which was relatively low. Long-term survival was similar in both groups, with a tendency to better progress in Group A in the period from the 2^nd–5^th years following the transplant.

Keywords:
compatibility index – heart transplant – acute cellular rejection – infections – tumours

Sources

1. Opelz G, Mytilineos J, Scherer D et al. Survival of DNA HLA DR typed and matched cadaver kidney transplant. The Collaborative Transplant Study. Lancet 1991; 338: 461–463.

2. Held PJ, Kahan BD, Hunsicker et al. The impact of HLA mismatches on the survival of first cadaveric kidney transplants. N Engl J Med 1994; 331: 765–770.

3. Opelz G, Döhler B. Impact of HLA mismatching on incidence of posttransplant non-hodgkin lymfoma after kidney transplantation. Transplantation 2010; 89: 567–572.

4. Opelz G, Döhler B. Association of mismatches for HLA-DR with incidence of posttransplant hip fracture in kidney transplant recipients. Transplantation 2010; 24 Epub ahead of print.

5. Mancini MJ, Connors AF Jr, Wang XQ et al. HLA matching for simultaneous pankreas-kidney transplantation in the United States: a multivariable analysis of the UNOS data. Clin Nephrol 2002; 57: 27–37.

6. Gruber SA, Katz S, Kaplan B et al. Initial results of solitary pankreas pransplants performed without regard to donor/recipient HLA mismatching. Transplantation 2000; 70: 388–391.

7. Markus BH, Duquesnoy RJ, Blaheta RA et al. Role of HLA antigens in liver transplantation with special reference to cellular imine reaction. Langenbecks Arch Surg 1998; 383: 87–94.

8. Meng XQ, Zhang X, Fan J et al. Detection of human leukocyte antigen compatibility and antibodies in liver transplantation in China. Hepatobiliary Pancreat Dis Int 2009; 8: 141–145.

9. Balan N, Ruppert K, Demetris AJ et al. 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 2008; 48: 878–888.

10. Quantz MA, Bennett LE, Meyer DM et al. Does human leukocyte antigen matching influence the outcome of lung transplantation? An analysis of 3 549 lung transplantations. J Heart Lung Transplant 2000; 19: 473–479.

11. Yacoub M, Festenstein H, Doyle P et al. The influence of HLA matching in cardiac allograft recipients receiving cyklosporine and azathioprine. Transplant Proc 1987; 19: 2487–2489.

12. Smith JD, Rose ML, Pomerance A et al. Reduction of cellular rejection and increase in longer-term survival after heart transplantation after HLA-DR matching. Lancet 1995; 346: 1318–1322.

13. Mascaretti L, Poli F, Scalamogna M et al. HLA-DR matching defined by DNA typing in heart transplantation. Transplant Proc 1997; 29: 1464–1466.

14. Sheldon S, Hasleton PS, Yonan NA et al. Rejection in heart transplantation strongly correlates with HLA-DR antigen mismatch. Transplantation 1994; 58: 719–722.

15. Taylor CJ, Smith SI, Sharples LD et al. Human leukocyte antigen compatibility in heart transplantation: evidence for a differential role of HLA matching on short-and medium-term patient survival. Transplantation 1997; 63: 1346–1351.

16. Opelz G, Wujciak T, Döhler B et al. HLA compatibility and organ transplant survival. Collaborative Transplant Study. Rev Immunogenet 1999; 1: 334–342.