INFLUENCE OF HUMAN-LEUKOCYTE ANTIGEN MATCHING ON LIVER ALLOGRAFT SURVIVAL AND REJECTION - THE DUALISTIC EFFECT

To date only one published large series of human leukocyte antigen mat ching and liver allograft survival exists, and considerable confusion has arisen about the advantage or disadvantage of human leukocyte anti gen matching. In the present study we have reinvestigated the relation ship between human leukocyte antigen mismatch and graft survival in 46 6 first liver allografts, seeking to clarify the relationship between human leukocyte antigen and both acute rejection and the vanishing bil e duct syndrome. In view of current criticism regarding the accuracy o f serological tissue typing for human leukocyte antigen-DR, we have us ed both classic serology and restriction fragment length polymorphism analysis to ensure the accurate assignment of recipient DR types. In a ddition, we have used polymerase chain reaction amplification and alle le-specific and sequence-specific oligonucleotide probes to retest the hypothesis that human leukocyte antigen class II matching may increas e susceptibility to the vanishing bile duct syndrome. One-year graft s urvival was significantly lower in patients with zero or two human leu kocyte antigen-A mismatches (52% and 63%, respectively) than in those with one human leukocyte antigen-A mismatch (69%) (p = 0.016 and p = 0 .018). A similar effect of B mismatching was observed, with a 1-yr gra ft survival of 73% for those with one compared with 60% for those with two human leukocyte antigen -B mismatches. In contrast no correlation was found between DR mismatch and graft survival. Human leukocyte ant igen class I matching appears to influence graft survival largely thro ugh the occurrence of acute rejection and the development of the vanis hing bile duct syndrome. In those patients who underwent liver biopsie s, 49% (28 of 57) without acute rejection had a single B mismatch comp ared with 32% (88 of 263) with acute rejection (chi2 = 5.5, p < 0.025) . In addition, a complete human leukocyte antigen-A mismatch was more common in those who developed the vanishing bile duct syndrome than in those with normal graft function (54% vs. 38%; chi2 = 4.26, p < 0.05) . In contrast to previous reports from this unit, no relationship betw een human leukocyte antigen-DR or -DQ mismatch and the vanishing bile duct syndrome could be detected. These findings indicate that human le ukocyte antigen class I compatibility exerts a dual effect on the surv ival of primary liver allografts. Although some human leukocyte antige n-A and -B matching may be desirable for liver transplantation, full c lass I matching may have an adverse effect.