It is not clear how HLA compatibility influences acute rejection and postoperative complications in cadaveric liver transplantation, and even less is known about this in pediatric living-related liver transplantation (LRLT). This study assessed relationships between HLA compatibility and rejection rates and complications in pediatric LRLT.
A total of 84 liver transplantations were performed at our center between December 1988 and October 2003. Data from 14 pediatric patients (8 males, 6 females; mean age, 12.1 years; range, 1-15 years) receiving LRLT in which the donor and recipient HLA genotypes were determined preoperatively were retrospectively investigated. Indications for liver transplantation were Wilson’s disease (n=7), biliary atresia (n=3), cryptogenic cirrhosis (n=2), Alagille syndrome (n=1), and Byler’s disease (n=1). Three patients (21.4%) developed biliary complications (biliary leakage or bile duct stenosis). Three other children (21.4%) developed vascular complications of hepatic artery thrombosis and/or stenosis. Concerning HLA-A, -B, and –DR mismatches, 1 patient had zero mismatches, 1 had one mismatch, 2 had 2 mismatches, 8 had 3 mismatches, 1 had 4 mismatches, and 1 had 5 mismatches. Tacrolimus plus low-dose steroids, and cyclosporine-A plus low-dose steroids, were used as basic immunosuppressive drugs. All 14 patients (100%) are currently alive at follow-up times of 3-146 months posttransplantation (mean, 35.07 ± 9.07 months). Eight patients (57.1%) were diagnosed with acute rejection. Concerning numbers of HLA mismatches in these 8 cases, 1 patient (12.5%) had zero mismatches, 1 (12.5%) had 2 mismatches, 5 (62.5%) had 3 mismatches, and 1 (12.5%) had 4 mismatches. The incidence of acute rejection was not correlated with number of HLA mismatches (all types) (P > 0.05) or with number of HLA class 1 (A and B) mismatches (P > 0.05); however, it was negatively correlated with number of HLA class 2 (-DR) mismatches (P = 0.02). Arterial and biliary complications were not correlated with any of these categories of HLA compatibility. In conclusion, our results provided no evidence that closeness of donor-recipient HLA-matching influences outcome in pediatric LRLT. According to our data, HLA mismatches are not associated with higher incidence of acute rejection or with other complications in this patient group.