Relevance of HLA compatibility in living donor liver transplantation: the double‐edged sword associated with the patient outcome

HLA compatibility in living donor liver transplantation ( LDLT ) seems relevant to the acceptability of graft livers because LDLT recipients often share most or some part of HLA s with the respective donors. This study retrospectively investigated whether HLA compatibility affected the outcome of LDLT . Three hundred ninety LDLT s were performed in this hospital, and 346 pairs of HLA s ( HLA ‐ A , B , DR ) were retrieved from the medical record between O ctober 1996 and M arch 2011. The dates of the deaths were censored when a recipient apparently died of or was retransplanted by other causes than graft failure because of host‐versus‐graft ( HVG ) response to purely analyze the outcomes of LDLT in view of HVG response. The relationship between HLA compatibility and graft‐versus‐host disease ( GVHD ) was also analyzed. No recipients with recipient‐against‐donor HLA mismatch ( R → D MM ) 0 experienced graft failure by HVG response. On the other hand, three of five recipients with “ R → D MM 0” together with “donor‐against‐recipient MM 3” died of fatal GVHD . HLA compatibility in LDLT not only affected the long‐term acceptance of graft livers but also the risk of fatal GVHD .