Evidence map›Paper›PMID 41856570›Full record

ArticleThe European respiratory journal2026

The influence of HLA matching on graft survival in lung transplant recipients is indication specific: a UNOS database analysis.

Afolarin A Otunla, Kumaran Shanmugarajah, Ghazel Mukhtar, Sarah Nabulsi, Daniel Dolan, Justin Salciccioli, Dominic C Marshall, Maria Lucia Madariaga, Joseph Shalhoub

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The European respiratory journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Afolarin A OtunlaDivision of Surgery and Interventional Science, University College London, London, UK.ORCID https://orcid.org/0000-0002-9091-7853
Kumaran ShanmugarajahDepartment of Surgery, University of Chicago, Chicago, IL, USA.
Ghazel MukhtarImperial College School of Medicine, Imperial College London, London, UK.
Sarah NabulsiDepartment of Life Sciences, Imperial College London, London, UK.
Daniel DolanDepartment of Surgery, University of Chicago, Chicago, IL, USA.ORCID https://orcid.org/0000-0002-2592-7641
Justin SalciccioliDepartment of Critical Care, Brigham and Women's Hospital, Boston, MA, USA.ORCID https://orcid.org/0000-0001-8092-0883
Dominic C MarshallDepartment of Surgery and Cancer, Imperial College London, London, UK.
Maria Lucia MadariagaDepartment of Surgery, University of Chicago, Chicago, IL, USA.
Joseph ShalhoubAcademic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK j.shalhoub@imperial.ac.uk.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLung transplantation offers definitive treatment for end-stage pulmonary disease, but graft survival remains inferior to other solid organ transplants. A key driver of graft loss is antibody-mediated rejection triggered by donor-recipient human leukocyte antigen (HLA) mismatch. Although HLA matching is not currently used in lung allocation due to organ scarcity and urgency of transplant, understanding its impact could improve risk stratification and outcomes. This study aimed to assess the effect of HLA compatibility on lung graft survival using a large multicentre database and to explore whether this relationship varies by transplant indication.

methodsWe conducted a retrospective cohort study of 37 091 lung transplant recipients in the UNOS/OPTN database. Patients were grouped by HLA mismatch (0-2

resultsHLA-DR mismatch was associated with increased graft failure risk at 1 year (hazard ratio (HR) 1.38, 95% CI 1.00-1.90; p=0.048) and 5 years (HR 1.20, 95% CI 1.03-1.40; p=0.020). Stratified analyses showed this effect was found exclusively in those with COPD or interstitial pneumonia. In COPD, HLA-DR mismatch significantly increased failure risk at 1 year (HR 2.88, 95% CI 1.34-6.19; p=0.007). In interstitial pneumonia, 5-year graft failure risk also rose with mismatch (HR 1.28, 95% CI 1.03-1.58; p=0.026).

conclusionsThe present study is the first to demonstrate that HLA-DR mismatch adversely affects lung graft survival in an indication-specific manner. This finding supports the development of indication-specific strategies in post-transplant surveillance and immunosuppression.

Indexed as

Graft SurvivalHistocompatibility TestingHLA AntigensHLA-DR AntigensLung TransplantationAdultAgedDatabases, FactualFemaleGraft RejectionHumansKaplan-Meier EstimateLung Diseases, InterstitialMaleMiddle AgedProportional Hazards ModelsHLA AntigensHLA-DR Antigens

Identifiers

PMID41856570
PMCPMC13550823

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