Brief Article
Copyright ©2010 Baishideng. All rights reserved
World J Gastroenterol. Jul 21, 2010; 16(27): 3457-3464
Published online Jul 21, 2010. doi: 10.3748/wjg.v16.i27.3457
Impact of human leukocyte antigen mismatching on outcomes of liver transplantation: A meta-analysis
Xiang Lan, Ming-Man Zhang, Cong-Lun Pu, Chun-Bao Guo, Quan Kang, Ying-Chun Li, Xiao-Ke Dai, Yu-Hua Deng, Qiang Xiong, Zhi-Mei Ren
Xiang Lan, Ming-Man Zhang, Cong-Lun Pu, Chun-Bao Guo, Quan Kang, Ying-Chun Li, Xiao-Ke Dai, Yu-Hua Deng, Qiang Xiong, Zhi-Mei Ren, Department of Hepatobiliary Surgery and Liver Transplantation Centre, Children’s Hospital of Chongqing Medical University, 136, Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China
Author contributions: Lan X designed the study, wrote the paper and reviewed all articles for inclusion with Pu CL and Guo CB; Zhang MM performed the final consensus review and the final data analysis; all authors contributed to this paper.
Correspondence to: Ming-Man Zhang, MD, PhD, Director, Department of Hepatobiliary Surgery and Liver Transplantation Centre, Children’s Hospital of Chongqing Medical University, 136, Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China. doczhangmm@163.com
Telephone: +86-23-63633341
Received: January 4, 2010
Revised: February 20, 2010
Accepted: February 27, 2010
Published online: July 21, 2010
Abstract

AIM: To assess the effect of human leukocyte antigen (HLA) mismatching on liver graft outcome and acute rejection from a meta-analysis of available cohort studies.

METHODS: Articles in PubMed/MEDLINE, EMBASE and the Cochrane database from January 1970 to June 2009, including non-English literature identified in these databases, were searched. Only studies comparing HLA or sub-phenotype matching with mismatching were extracted. The percentage of graft survival was extracted by “Engauge Digitizer” from survival curves if the raw data were not displayed. A meta-analysis was performed when at least 3 studies provided data.

RESULTS: Sixteen studies met the inclusion criteria. A lower number of HLA mismatches (0-2 vs 3-6) did reduce the incidence of acute rejection (relative risk: 0.77, P = 0.03). The degree of HLA mismatching (0-2 vs 3-6) had no significant effect on 1-year [hazard ratio (HR): 1.04, P = 0.68] and 5-year (HR: 1.09, P = 0.38) graft survival. In sub-phenotype analysis, the degree of HLA-A, B and DR mismatching (0 vs 1-2) had no significant effect on 1-year and 5-year graft survival, either. The HRs and P-values were 0.95, 0.71 (HLA-A, 1-year); 1.06, 0.60 (HLA-A, 5-year); 0.77, 0.16 (HLA-B, 1-year); 1.07, 0.56 (HLA-DR, 1-year); 1.18, 0.23 (HLA-DR, 5-year), respectively.

CONCLUSION: The results of this systematic review imply that good HLA compatibility can reduce the incidence of acute rejection in spite of having no influence on graft outcomes. To obtain a short recovery time and minimize rejection post transplantation, HLA matching studies should be considered before the operation.

Keywords: Human leukocyte antigen; Mismatching; Liver transplantation; Meta-analysis; Graft rejection