UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Donor-recipient HLA-A mismatching is associated with hepatic artery thrombosis, sepsis, graft loss and reduced survival after liver transplantation

Bricogne, Christopher; Halliday, Neil; Fernando, Raymond; Tsochatzis, Emmanuel A; Davidson, Brian R; Harber, Mark; Westbrook, Rachel H; (2022) Donor-recipient HLA-A mismatching is associated with hepatic artery thrombosis, sepsis, graft loss and reduced survival after liver transplantation. Liver Transplantation , 28 (8) pp. 1306-1320. 10.1002/lt.26458. Green open access

[thumbnail of Liver Transplantation - 2022 - Bricogne - Donor recipient human leukocyte antigen A mismatching is associated with hepatic.pdf]
Preview
Text
Liver Transplantation - 2022 - Bricogne - Donor recipient human leukocyte antigen A mismatching is associated with hepatic.pdf

Download (959kB) | Preview

Abstract

HLA matching is not routinely performed for liver transplantation as there is no consistent evidence of benefit, however the impact of HLA mismatching remains uncertain. We explored the effect of class I and II HLA mismatching on graft failure and mortality. 1042 liver transplants performed at a single centre, between 1999 and 2016 with available HLA typing data were included. Median follow up period was 9.38 years (IQR 4.9-14) and 350/1042 (33.6%) transplants resulted in graft loss and 280/1042 (26.9%) in death. Graft loss and mortality were not associated with the overall number of mismatches at HLA-A, -B, -C, -DR and -DQ loci. However, graft failure and mortality were both increased in the presence of one (p = 0.004 and p = 0.01) and two (p = 0.01 and p = 0.04) HLA-A mismatches. Elevated hazard ratios for graft failure and death were observed with HLA-A mismatches in univariate and multivariate Cox proportional hazard models. Excess graft loss with HLA-A mismatch (138/940 (14.7%) of mismatched compared to 6/102 (5.9%) matched transplants) occurred within the first-year following transplantation (OR 2.75, p = 0.02). Strikingly, all grafts lost due to hepatic artery thrombosis were in HLA-A mismatched transplants (31/940 vs. 0/102), as were those lost due to sepsis (35/940 vs. 0/102). In conclusion, HLA-A mismatching was associated with increased graft loss and mortality. The poorer outcome for The HLA mismatched group was due to hepatic artery thrombosis and sepsis and these complications occurred exclusively with HLA-A mismatched transplants. This suggests that HLA-A mismatching is important for post-transplant outcomes and knowledge of HLA-A status may enable enhanced surveillance and interventions to reduce risk of complications or stratified HLA-A matching in high-risk recipients.

Type: Article
Title: Donor-recipient HLA-A mismatching is associated with hepatic artery thrombosis, sepsis, graft loss and reduced survival after liver transplantation
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/lt.26458
Publisher version: https://doi.org/10.1002/lt.26458
Language: English
Additional information: Copyright © 2022 The Authors. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10146526
Downloads since deposit
4Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item