Reduction of cellular rejection and increase in longer-term survival after heart transplantation after HLA-DR matching

HLA matching in cardiac transplants is perceived as being logistically difficult. We studied 1135 consecutive primary cardiac allografts between 1980 and 1994 to assess the effect of HLA mismatching on long-term graft survival and cellular rejection episodes within 3 months of transplantation. We found a significant association between HLA-DR mismatching and the number of episodes of rejection (no mismatch 0·80 [SE 0·13], one mismatch 1·22 [0·06], two mismatches 1·42 [0·06], p<0·05). We found a similar correlation between the total number of biopsy specimens showing evidence of cellular rejection and HLA-DR mismatch. The time between operation and the first rejection episode shortened with increasing HLA-DR mismatch (no mismatch 85·5 [37·3] days, one mismatch 43·1 [8·1], two mismatches 24·1 [2·9], p<0·05). Furthermore, the proportion of patients with no evidence of rejection correlated with HLA-DR incompatibility. A significant association between improved graft survival and HLA-DR mismatching was found over 1, 5, and 10 years after transplantation (no mismatch 1 year 92%, 5 years 83%, 10 years 76%, one mismatch 1 year 81%, 5 years 73%, 10 years 59%, and two mismatches 78% 1 year, 5 years 70%, and 10 years 52%, P=0·02). Increased efforts to prospectively HLA match patients has resulted in 25% of patients transplanted between January and May 1995 (n=13/52) receiving grafts matched for HLA-DR. HLA matching reduces the frequency and severity of acute cardiac allograft rejection and improves graft survival for up to 10 years. Our preliminary results suggest that it is possible to use HLA matching prospectively for our selection of recipients.