Table 1_Analyzing the impact of human leukocyte antigen mismatch on the incidence of prostate cancer and the advantage of T cell therapy in patients after kidney transplantation based on the United Network for Organ Sharing database.docx

BackgroundWe aim to analysis the impact of Human Leukocyte Antigen (HLA) mismatch between kidney transplant donors and recipients on the incidence of prostate cancer after kidney transplantation (KT). Meanwhile, understanding the use of T cell therapy is of great importance after kidney transplantation from the perspective of prostate cancer occurrence.
MethodsA retrospective study was conducted on kidney transplant recipients based on the United Network for Organ Sharing (UNOS) database from 2000 to 2019. General demographic data, socio-economic and educational data, personal medical history, immunosuppressive therapy regimens, and HLA typing of donors and recipients were collected to analyze the impact of: (1) baseline patient characteristics; (2) HLA mismatch; and (3) HLA subtype mismatch on the incidence of prostate cancer after transplantation.
ResultsA total of 268–994 kidney transplant recipients were included, with 1–910 newly diagnosed prostate cancer patients after surgery. Both univariate and Cox multivariate analysis discovered that the use of T cell therapy could reduce the risk of prostate cancer after KT [0.89(0.86~0.91)]. We also found HLA mismatch ≥ 3 is a risk factor of prostate cancer after transplantation [1.07(1.02~1.11)]. Further subgroup analysis was conducted on HLA mismatch. The Cox multivariate analysis of HLA-A (0–2), HLA-B (0–2), and HLA-DR (0–2) mismatch showed that 2-mismatch in HLA-A and HLA-B was a risk factor of prostate cancer after KT [1.19(1.01~1.40)]; 2-mismatch and 1-mismatch were both risk factors of prostate cancer after KT in the HLA-DR group [1.32(1.13~1.54)], [1.20(1.03~1.39)].
ConclusionsFrom the perspective of prostate cancer occurrence after transplantation, the use of T cell therapy is of great significance. HLA mismatch ≥ 3 was a risk factor of prostate cancer after KT. HLA-A and HLA-B 2-mismatch were risk factors of prostate cancer after KT, while HLA-DR 1-mismatch and 2-mismatch were both risk factors of prostate cancer after KT. This research contributed to the focus on the relationship between induction therapy and cancer occurrence after KT, and also provide guidance for reasonable selections of HLA typing of prostate cancer before KT.

研究背景：本研究旨在分析肾移植（Kidney Transplantation, KT）供者与受者之间的人类白细胞抗原（Human Leukocyte Antigen, HLA）错配对肾移植术后前列腺癌发病率的影响。同时，从前列腺癌发生的视角，了解肾移植术后T细胞治疗的应用价值亦具有重要意义。
研究方法：本研究基于2000年至2019年美国器官共享联合网络（United Network for Organ Sharing, UNOS）数据库，对肾移植受者开展回顾性研究。收集患者的一般人口学资料、社会经济与教育背景数据、个人病史、免疫抑制治疗方案以及供受者的HLA分型信息，以分析以下因素对移植后前列腺癌发病率的影响：(1) 患者基线特征；(2) HLA错配情况；(3) HLA亚型错配情况。
研究结果：本研究共纳入268994名肾移植受者，其中术后新发前列腺癌患者共1910例。单因素及Cox多因素分析均显示，T细胞治疗的应用可降低肾移植术后前列腺癌的发病风险[0.89(0.86~0.91)]。本研究同时发现，HLA错配数≥3是肾移植术后前列腺癌的危险因素[1.07(1.02~1.11)]。进一步针对HLA错配开展亚组分析，对HLA-A、HLA-B及HLA-DR错配（0~2个错配）的Cox多因素分析结果显示：HLA-A与HLA-B各存在2个错配时，为肾移植术后前列腺癌的危险因素[1.19(1.01~1.40)]；在HLA-DR组中，存在2个错配及1个错配均为肾移植术后前列腺癌的危险因素[1.32(1.13~1.54)]、[1.20(1.03~1.39)]。
研究结论：从肾移植术后前列腺癌发生的视角来看，T细胞治疗的应用具有重要意义。HLA错配数≥3为肾移植术后前列腺癌的危险因素；HLA-A与HLA-B各存在2个错配、HLA-DR存在1个及2个错配均为肾移植术后前列腺癌的危险因素。本研究有助于关注肾移植术后诱导治疗与肿瘤发生之间的关联，并为肾移植术前针对前列腺癌患者的HLA分型合理选择提供指导依据。