HLA Compatibility and Heart Transplant Survival Using A Validated Matching Algorithm Andrew L. Rivard, MD, MS, Cleveland Clinic Abu Dhabi Naoru Koizumi,

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Presentation transcript:

HLA Compatibility and Heart Transplant Survival Using A Validated Matching Algorithm Andrew L. Rivard, MD, MS, Cleveland Clinic Abu Dhabi Naoru Koizumi, PhD, George Mason University

Relevant Financial Relationship Disclosure Statement Human Leukocyte Compatibility and Heart Transplant Survival Using A Validated Matching Algorithm I will not discuss off label use and/or investigational use No relevant financial relationships exist related to this presentation.

Outline Post heart transplant survival determinants Donor / recipient tissue typing UNOS – STARS file HLA mismatching algorithm Survival as based upon HLA mismatch Future 3

UNET Web Data Entry Form 4

Methods UNOS - STARS file 2003-2015 121,368 HTx recipients 209 US transplant centers HLA mismatching algorithm 0-6 mismatches HLA-A, -B, -DR >4 missing loci excluded 5

Methods UNOS - STARS file 2003-2015 121,368 HTx recipients 209 US transplant centers HLA mismatching algorithm 0-6 mismatches HLA-A, -B, -DR >4 missing loci excluded 6

Methods UNOS - STARS file 2003-2015 121,368 HTx recipients 209 US transplant centers HLA mismatching algorithm 0-6 mismatches HLA-A, -B, -DR >4 missing loci excluded 7

Methods UNOS - STARS file 2003-2015 121,368 HTx recipients 209 US transplant centers HLA mismatching algorithm 0-6 mismatches HLA-A, -B, -DR >4 missing loci excluded 8

Methods UNOS - STARS file 2003-2015 121,368 HTx recipients 209 US transplant centers HLA mismatching algorithm 0-6 mismatches HLA-A, -B, -DR >4 missing loci excluded 9

Methods UNOS - STARS file 2003-2015 121,368 HTx recipients 209 US transplant centers HLA mismatching algorithm 0-6 mismatches HLA-A, -B, -DR >4 missing loci excluded 10

Database Relationship Design Individual Table 11

HLA Table 12

HLA Table 13

Mismatch Algorithm Step 1 – Data validation Demonstrate data validity Step 2 – Donor-Recipient mismatching Logic (A ? X) comparison Error handling Demonstration of equivalency 14

Mismatch Algorithm Step 1 – Data validation Demonstrate data validity Step 2 – Donor-Recipient mismatching Logic (A ? X) comparison Error handling Demonstration of equivalency 15

User Interface 16

Results 21,878 HTx patients met criteria 398 patients (0-1 mismatch) 3 yr Survival ≤ 3 mismatch ≥ 4 mismatch (p=0.001) Cox regression HLA-DR (p=0.003) 17

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Survival Based Upon Mismatch 20

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Conclusion Largest analysis of HLA data to date UNOS independent mismatching algorithm Survival ≤ 3 mismatch ≥ 4 mismatch *HLA-DR Thompson JS, Thacker Ii LR, Takemoto S. The influence of conventional and cross-reactive group HLA matching on cardiac transplant outcome: an analysis from the United Network of Organ Sharing Scientific Registry. Transplantation 2000; 69: 2178. 14535 patients! 22

Thank you! 23