AIM: To assess the effect of human leukocyte antigen (HLA) mismatching on liver graft outcome and acute rejection from a meta-analysis of available cohort studies.

METHODS: Articles in PubMed/MEDLINE, EMBASE and the Cochrane database from January 1970 to June 2009, including non-English literature identified in these databases, were searched. Only studies comparing HLA or sub-phenotype matching with mismatching were extracted. The percentage of graft survival was extracted by “Engauge Digitizer” from survival curves if the raw data were not displayed. A meta-analysis was performed when at least 3 studies provided data.

RESULTS: Sixteen studies met the inclusion criteria. A lower number of HLA mismatches (0-2 vs 3-6) did reduce the incidence of acute rejection (relative risk: 0.77, P = 0.03). The degree of HLA mismatching (0-2 vs 3-6) had no significant effect on 1-year [hazard ratio (HR): 1.04, P = 0.68] and 5-year (HR: 1.09, P = 0.38) graft survival. In sub-phenotype analysis, the degree of HLA-A, B and DR mismatching (0 vs 1-2) had no significant effect on 1-year and 5-year graft survival, either. The HRs and P-values were 0.95, 0.71 (HLA-A, 1-year); 1.06, 0.60 (HLA-A, 5-year); 0.77, 0.16 (HLA-B, 1-year); 1.07, 0.56 (HLA-DR, 1-year); 1.18, 0.23 (HLA-DR, 5-year), respectively.

CONCLUSION: The results of this systematic review imply that good HLA compatibility can reduce the incidence of acute rejection in spite of having no influence on graft outcomes. To obtain a short recovery time and minimize rejection post transplantation, HLA matching studies should be considered before the operation.

Impact of human leukocyte antigen mismatching on outcomes of liver transplantation: a meta-analysis.

Donor liver shortage is a persistent problem in liver transplantation A more liberal donor acceptance policy may be a possible solution However, this might put recipients at risk for initial poor function or even non-function of the graft Therefore risk factors for initial graft dysfunction should be identified, preferably by using an uniform definition of primary graft dysfunction or non-function We retrospectively analysed 125 adult liver transplantations in order to identify risk factors for initial poor function and primary non-function Donor, recipient pretransplant and surgical parameters were evaluated Since there is no consensus on the criteria of dysfunction we used two definitions known from literature No risk factors for postoperative dysfunction could be identified for either of the two definition sets Furthermore, the definition set that included ALAT, prothrombin time and bile production in the first 72 h to identify poor graft function showed no relation with graft or recipient outcome The other set, using ASAT and prothrombin time, determined from day 2 to day 7, showed that patients with a primary dysfunction had significantly higher morbidity and mortality compared to patients with a well functioning graft We conclude that initial poor function after liver transplantation remains unpredictable, irrespective of the way it is defined Moreover, our analysis shows that initial poor function can also develop in recipients that receive 'non-marginal' grafts without prolonged ischemia times These results may support a more liberal selection of donor livers

Poor initial graft function after orthotopic liver transplantation: can it be predicted and does it affect outcome? An analysis of 125 adult primary transplantations.

Background: Except for primary biliary cirrhosis, primary sclerosing cholangitis (PSC) is now the commonest indication for liver transplantation in Sweden. There are several specific problems related to post-transplantation life in these patients. Methods: We analyzed a 10-year cohort of 47 patients transplanted at our center. Results: Incidental biliary carcinoma was diagnosed in 13%, with a 2-year survival of only 17%, compared with 70% in the other patients. The 2-year survival has improved considerably (to 82%) in recent years. Quality of life was much or slightly improved in 80%. The colitis was much or slightly improved in 65%, with some deterioration in only 6%. No patient developed colonic carcinoma. Previous biliary tract surgery was identified as a risk factor for a worse 1-year mortality. Conclusions: Liver transplantation for PSC is now associated with a high survival rate and an improvement in the quality of life and course of ulcerative colitis. Previous biliary tract surgery is a risk facto...

Follow-up after liver transplantation for primary sclerosing cholangitis: effects on survival, quality of life, and colitis.

Influence of human leukocyte antigen mismatching on rejection development and allograft survival in liver transplantation: is the relevance of HLA-A locus matching being underestimated?

Liver transplantation has changed the future of patients with end-stage liver disease. Nowadays one year patient survival reaches 90% in experienced centers. Most patients die in the early phase after transplantation. After this initial period patient survival approximates survival curves of the healthy population. This thesis focuses on early graft function after orthotopic liver transplantation and the factors determining such function.

/pdf/studies-on-predictability-of-early-graft-function-after-5czaowtnb0.pdf

Studies on predictability of early graft function after liver transplantation

In LIVER transplantation (LT), the role of HLA compatibility remains controversial. Indeed, several groups 1 report a beneficial effect of HLA matching on survival rates and the incidence of rejection, whereas others fail to demonstrate any advantage between poorly- and well-matched patients. 2,3 This retrospective study analyzes the effects of mismatches and crossmatches on liver-transplanted patients and graft survival as well as post-operative events.

Effect of HLA compatibility on liver transplantation: is it a predictive factor of postoperative outcome?

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Effect of HLA compatibility on liver transplantation: is it a predictive factor of postoperative outcome?