HISTOCOMPATIBILITY AND LIVER-TRANSPLANTATION

Background. The role of histocompatibility between donor and recipient in liver transplant rejection is unclear because of a paucity of data . The influence of human leukocyte antigen (HLA) type on immunologic g raft loss was examined for primary liver transplantations performed at this center. Methods. Immunologic graft loss included patient death o r retransplantation as a result of rejection or impending graft loss c aused by either late hepatic artery thrombosis or severe, unremitting rejection requiring FK 506 rescue therapy. HLA A, B, and DR matching w as available on 205 donor-recipient combinations, and an additional 31 patients had A and B matching only. Results. A mismatch of class I an tigens (HLA A and B) was predictive of immunologic graft loss (p = 0.0 18). DR mismatch did not correlate with graft loss. When the A and B l oci were analyzed separately, an A mismatch correlated significantly w ith immunologic graft loss (p = 0.02), in contrast to a B mismatch (p = 0.17). Better matching significantly improved patient survival (p = 0.02) and overall graft survival (p = 0.009). Conclusions. The benefic ial effect of HLA class I antigen compatibility on liver transplantati on outcome is in contrast to pancreatic and kidney transplantation in which class II antigen matching but not class I matching is beneficial . Immunologic mechanisms of hepatic allograft rejection may differ fro m those involved in kidney transplant rejection.