Sara Gozzini¹, David Briggs³, Angela Evans³, Khalid Sharif¹, Paolo Muiesan², Darius Mirza², Girish Gupte¹

¹Liver Unit, Birmingham Children's Hospital, Birmingham, United Kingdom; ²Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom; ³Histocompatibility and Immunogenetic, National Blood Service, Birmingham, United Kingdom

Background: HLA mismatch and rejection within first 3 months is  known in kidney transplantation, but clinical significance is unclear in intestinal transplantation (ITx). The aim was identify any association between HLA mismatch and early acute rejection (EAR)

Material and Methods: Retrospective reviewed on 74 ITx [isolated bowel (IB), liver bowel (LB)] performed since 1998. 34 recipients ( 6 IB and 28 LB) with EAR were included and the number, severity of rejection episodes were compared to total number of HLA mismatches, in class I, class II and at different locus ( A,B,DR) for each recipient. Higher HLA mismatch= > 2 mismatches

Discussion: None of the children with EAR had histopathological changes of AMR. No child had a full HLA match and 70.6% of them had 5 to 6 mismatches. There was no correlation between the total number of HLA mismatches, number of mismatches at class I and class II separately in each patient and recurrence, severity of rejection. There was no significant correlation between the number of matches at each single locus and the number or grade of rejection. (locus A,B, DR  p- value 0.51, 0.54, 0.07). Higher mismatch was found to develop an earlier onset of rejection, within 30 days post transplants (p-value 0.029) Limitation- no availability of donor specific antibodies. 

Conclusions: Our study shows that HLA status does not seem to have a role in the recurrence and severity of rejection post ITx transplant. However an increased vigilance for EAR should be performed in children with higher HLA mismatch