Transplantation

Background Solid organ transplant recipients have heightened risk for diffuse large B-cell lymphoma (DLBCL). The role of donor-recipient HLA mismatch and recipient HLA type on DLBCL risk are not well established. Methods We examined 172,231 U.S. kidney, heart, pancreas, and lung recipients transplanted between 1987 and 2010, including 902 with DLBCL. Incidence rate ratios (IRRs) were calculated using Poisson regression for DLBCL risk in relation to HLA mismatch, types, and zygosity, adjusting for sex, age, race/ethnicity, year, organ, and transplant number. Results Compared to recipients who had two HLA-DR mismatches, those with zero or one mismatches had reduced DLBCL risk, (zero: IRR=0.76, 95%CI=0.61–0.95; one: IRR=0.83, 95%CI=0.69–1.00). In stratified analyses, recipients matched at either HLA-A, -B, or -DR had a significantly reduced risk of late-onset (>2 years after transplantation), but not early-onset, DLBCL, and there was a trend for decreasing risk with decreasing mismatch across all three loci (P=0.0003). Several individual recipient HLA-A, -B, -C, -DR, and –DQ antigens were also associated with DLBCL risk, including DR13 (IRR=0.74, 95%CI=0.57–0.93) and B38 (IRR=1.48, 95%CI=1.10–1.93), confirming prior findings that these two antigens are associated with risk of infection-associated cancers. Conclusions In conclusion, variation in HLA is related to susceptibility to DLBCL, perhaps reflecting intensity of immunosuppression, control of Epstein-Barr virus infection among transplant recipients, or chronic immune stimulation.

26636741

PMC4893345

CDC Public Access