Ann Lab Med.  2015 Jan;35(1):111-117. 10.3343/alm.2015.35.1.111.

The Impact of HLA and KIR Ligand Mismatching on Unrelated Allogeneic Hematopoietic Stem Cell Transplantation in Korean Adult Patients

• Park H
• Rho EY
• In JW
• Kim I
• Yoon SS
• Park S
• Shin S
• Park KU
• Song EY

• KMID: 2363157
• DOI: http://doi.org/10.3343/alm.2015.35.1.111

Abstract

BACKGROUND
The impact of HLA and KIR ligand mismatching on the outcome of hematopoietic stem cell transplantation (HSCT) remains unclear. Previous reports have identified considerable ethnic differences in the impact of HLA and KIR ligand mismatches, as well as KIR ligand status, on HSCT; however, to date, no data has been acquired in Korean adult patients.
METHODS
We investigated the association of high-resolution HLA matching on five loci (HLA-A, -B, -C, -DRB1, and -DQB1), KIR ligand mismatching, and KIR ligand status on the outcome of allogeneic HSCT from unrelated donors in 154 Korean adult patients treated at Seoul National University Hospital.
RESULTS
In a multivariate analysis, less than 9/10 allelic matches in five HLA loci was an independent risk factor for acute graft-versus-host disease (GVHD) (grade II to IV) (P=0.019, odds ratio [OR]=2.7). In addition, HLA-A allele mismatching was increasingly prevalent in patients with acute GVHD compared to patients without (61.9% vs. 34.5%, P=0.06). For KIR ligand status, the patient and donor combination of both C1/C1 ligands showed better event-free and overall survival than combinations with C2 ligand patients or donors (P=0.048, P=0.034, respectively) by log-rank test.
CONCLUSIONS
Korean adult transplant patients with less than 9 of 10 HLA allele matches in the HLA-A, -B, -C, -DRB1, and DQB1 loci have a higher likelihood of developing acute GVHD (grade II to IV). Impact of KIR ligand status on clinical outcome should be further studied in a larger patient population.

Keyword

HLA; KIR ligand; Mismatch; Hematopoietic stem cell transplantation

MeSH Terms

Adolescent
Adult
Alleles
Female
Genetic Loci
Graft vs Host Disease/etiology
HLA Antigens/*genetics/metabolism
*Hematopoietic Stem Cell Transplantation/adverse effects/standards
Histocompatibility Testing
Humans
Kaplan-Meier Estimate
Leukemia/mortality/therapy
Male
Middle Aged
Multivariate Analysis
Receptors, KIR/*chemistry/metabolism
Republic of Korea
Risk Factors
Transplantation, Homologous
Young Adult
HLA Antigens
Receptors, KIR

Figure

• 

  Fig. 1 Kaplan-Meier analysis of event-free and overall survival according to KIR ligand mismatch and ligand status following unrelated hematopoietic stem cell transplantation (HSCT) in Koreans. (A) Event-free survival in recipients with KIR ligand match (n=149) vs. KIR ligand mismatch (n=5), (B) Event-free survival in recipient-donor combination of both with C1/C1 (n=103) vs. recipients with C1/C2 or C2/C2 and donors with C1/C2 or C2/C2 (n=51), (C) Event-free survival in recipient with Bw4/Bw4 (n=28) vs. Bw4/Bw6 or Bw6/Bw6 (n=126), (D) overall survival in recipients with KIR ligand match (n=149) vs. KIR ligand mismatch (n=5), (E) overall survival in recipient-donor combination of both with C1/C1 (n=103) vs. recipients with C1/C2 or C2/C2 and donors with C1/C2 or C2/C2 (n=51), and (F) overall survival in recipient with Bw4/Bw4 (n=28) vs. Bw4/Bw6 or Bw6/Bw6 (n=126).Abbreviation: Rec, recipient.

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