TY - JOUR
T1 - Assessment of human leukocyte antigen matching algorithm PIRCHE-II on liver transplantation outcomes
AU - Kok, Gautam
AU - Verstegen, Monique Ma
AU - Houwen, Roderick Hj
AU - Nieuwenhuis, Edward Es
AU - Metselaar, Herold J
AU - Polak, Wojciech G
AU - van der Laan, Luc Jw
AU - Spierings, Eric
AU - den Hoed, Caroline M
AU - Fuchs, Sabine A
N1 - Funding Information:
This study was financially supported by Stichting Metakids (to Sabine A. Fuchs) and The Netherlands Organization for Health Research and Development (ZonMW TAS grant [project number: 116002008] and Clinical Fellow grant [project number: 90714537] to Sabine A. Fuchs). The funding sources had no influence on the design, implementation, reporting, and publishing of this study.
Funding Information:
This study was financially supported by Stichting Metakids (to Sabine A. Fuchs) and The Netherlands Organization for Health Research and Development (ZonMW TAS grant [project number: 116002008] and Clinical Fellow grant [project number: 90714537] to Sabine A. Fuchs). The funding sources had no influence on the design, implementation, reporting, and publishing of this study. The authors thank Sylvia de Visser-de Vlaming for her significant help with collection of the patient data and Remi Mahmoud and Simone Uniken Venema for guidance with the statistical analyses.
Publisher Copyright:
© 2022 The Authors. Liver Transplantation published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.
PY - 2022/8
Y1 - 2022/8
N2 - For liver transplantations, human leukocyte antigen (HLA) matching is not routinely performed because observed effects have been inconsistent. Nevertheless, long-term liver transplantation outcomes remain suboptimal. The availability of a more precise HLA-matching algorithm, Predicted Indirectly Recognizable HLA Epitopes II (PIRCHE-II), now enables robust assessment of the association between HLA matching and liver transplantation outcomes. We performed a single-center retrospective cohort study of 736 liver transplantation patients. Associations between PIRCHE-II and HLAMatchmaker scores and mortality, graft loss, acute and chronic rejection, ischemic cholangiopathy, and disease recurrence were evaluated with Cox proportional hazards models. Associations between PIRCHE-II with 1-year, 2-year, and 5-year outcomes and severity of acute rejection were assessed with logistic and linear regression analyses, respectively. Subgroup analyses were performed for autoimmune and nonautoimmune indications, and patients aged 30 years and younger, and older than 30 years. PIRCHE-II and HLAMatchmaker scores were not associated with any of the outcomes. However, patients who received transplants for autoimmune disease showed more acute rejection and graft loss, and these risks negatively associated with age. Rhesus mismatch more than doubled the risk of disease recurrence. Moreover, PIRCHE-II was inversely associated with graft loss in the subgroup of patients aged 30 years and younger with autoimmune indications. The absence of associations between PIRCHE-II and HLAMatchmaker scores and the studied outcomes refutes the need for HLA matching for liver (stem cell) transplantations for nonautoimmune disease. For autoimmune disease, the activated immune system seems to increase risks of acute rejection and graft loss. Our results may suggest the benefits of transplantations with rhesus matched but PIRCHE-II mismatched donor livers.
AB - For liver transplantations, human leukocyte antigen (HLA) matching is not routinely performed because observed effects have been inconsistent. Nevertheless, long-term liver transplantation outcomes remain suboptimal. The availability of a more precise HLA-matching algorithm, Predicted Indirectly Recognizable HLA Epitopes II (PIRCHE-II), now enables robust assessment of the association between HLA matching and liver transplantation outcomes. We performed a single-center retrospective cohort study of 736 liver transplantation patients. Associations between PIRCHE-II and HLAMatchmaker scores and mortality, graft loss, acute and chronic rejection, ischemic cholangiopathy, and disease recurrence were evaluated with Cox proportional hazards models. Associations between PIRCHE-II with 1-year, 2-year, and 5-year outcomes and severity of acute rejection were assessed with logistic and linear regression analyses, respectively. Subgroup analyses were performed for autoimmune and nonautoimmune indications, and patients aged 30 years and younger, and older than 30 years. PIRCHE-II and HLAMatchmaker scores were not associated with any of the outcomes. However, patients who received transplants for autoimmune disease showed more acute rejection and graft loss, and these risks negatively associated with age. Rhesus mismatch more than doubled the risk of disease recurrence. Moreover, PIRCHE-II was inversely associated with graft loss in the subgroup of patients aged 30 years and younger with autoimmune indications. The absence of associations between PIRCHE-II and HLAMatchmaker scores and the studied outcomes refutes the need for HLA matching for liver (stem cell) transplantations for nonautoimmune disease. For autoimmune disease, the activated immune system seems to increase risks of acute rejection and graft loss. Our results may suggest the benefits of transplantations with rhesus matched but PIRCHE-II mismatched donor livers.
UR - http://www.scopus.com/inward/record.url?scp=85128853881&partnerID=8YFLogxK
U2 - 10.1002/lt.26431
DO - 10.1002/lt.26431
M3 - Article
C2 - 35152544
SN - 1527-6465
VL - 28
SP - 1356
EP - 1366
JO - Liver Transplantation
JF - Liver Transplantation
IS - 8
ER -