Background: Donor against recipient (D-R) one-way human leukocyte antigen (HLA) mismatch (MM) seemed strongly associated with graft-versus-host disease (GVHD) after liver transplantation (LT). The aim of this study is to investigate the relevance of D-R one-way HLA MM in outcome of LT by analyzing Korean Organ Transplantation Registry (KOTRY) database.
Methods: We retrospectively analyzed 2,670 patients with HLA type data who underwent LT between April 2014 and December 2020 in KOTRY database. The patients were categorized into two groups whether D-R one-way HLA MM or not.
Results: Among 2,670 LT recipients, 18 patients were found to be D-R one-way HLA MM. All 18 D-R one-way HLA MM patients underwent LT from living donors who were mostly offspring (83.3%). D-R one-way HLA MM patients showed significantly higher mortality rate (P=0.003) and higher rate of GVHD prevalence (P<0.001). According to Cox regression analysis, deceased donor LT (hazard ratio [HR], 1.64; P=0.012), D-R one-way HLA MM at three loci (HR, 12.75; P<0.001), and retransplantation (HR, 2.01; P=0.036) were found to be the independent risk factors for patient death. Patients with D-R one-way HLA MM at three loci showed significantly lower overall survival comparing to patients without D-R one-way HLA MM. There were no significant differences in rejection-free survival and death-censored graft survival. In addition, D-R one-way HLA MM at three loci seemed to be strongly associated with the incidence of GVHD (odds ratio, 163.3; P<0.001, multivariate).
Conclusions: D-R one-way HLA MM occurs mainly in LT from living donors and D-R one-way HLA MM at three loci not only affects the overall survival of LT patients but also the incidence of GVHD. Therefore, careful consideration would be required in the LDLT of patients with D-R one-way HLA MM especially at three loci.