Korean J Transplant.  2023 Dec;37(4):269-276. 10.4285/kjt.23.0053.

One-way donor-to-recipient human leukocyte antigen mismatch and graft-versus-host disease in liver transplantation: an observational study of a single-center experience in Korea

• Yim SH
• Kim DG
• Lee JG
• Joo DJ
• Kim MS

• KMID: 2550238
• DOI: http://doi.org/10.4285/kjt.23.0053

Abstract

Background
Graft-versus-host disease (GVHD) is a rare, but potentially fatal complica- tion of liver transplantation. One-way human leukocyte antigens (HLA) mismatch has emerged as a risk factor for GVHD. However, the risk of mortality associated with HLA- one-way mismatch (OWMM) remains uncertain. We investigated the incidence and characteristics of GVHD.
Methods
In total, 899 patients who underwent liver transplantation at a single center were retrospectively reviewed. The incidence of GVHD and 1- and 5-year survival rates were compared according to whether HLA-OWMM developed.
Results
In the HLA-OWMM group, GVHD developed in two patients (14.3%). Nota-bly, GVHD was only observed in living donor liver transplant (LDLT) recipients in the HLA-OWMM group. The HLA-OWMM group exhibited a lower 1-year patient survival rate than the control (i.e., non-HLA-OWMM) group (78.6% vs. 90.7%, P=0.120). Howev-er, the 5-year survival rate in the HLA-OWMM group was similar to that in the control group (78.6% vs. 78.2%, P=0.821). When the HLA-OWMM group was further stratified by the number of mismatched loci, the 5-year survival rate was 83.3% in patients with HLA-OWMM at one to two loci and 75.0% in those with HLA-OWMM at three loci.
Conclusions
Despite the higher incidence of GVHD in LDLT recipients with HLA-OW-MM, the 5-year patient survival rates were comparable to those in recipients without HLA-OWMM. The decision to perform LDLT in patients with HLA-OWMM depends on the patient’s status and the organ supply of a specific region.

Keyword

Human leukocyte antigen; Graft vs host disease; Liver transplantation

Figure

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  Fig. 1 Comparison of patient survival after LT. (A) The HLA-OWMM group versus the control group. (B) Patients with HLA-OWMM at 1–2 or 3 loci versus the control group. (C) Living donor LT recipients in the HLA-OWMM group versus the control group. HLA, human leukocyte antigen; OWMM, one-way mismatch; LT, liver transplantation.

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