Improved renal allograft survival with selected HLA antigen matching.
We examined the influence of the three most frequent linkage disequilibrium antigen combinations, HLA 1-8, 2-12, and 3-7, on renal allograft survival. We reviewed the results of 214 first transplants to recipients sharing exactly two HLA-A or -B antigens with the donor, excluding failures caused by hyperacute rejection or technical factors. Actuarial graft survival for matches having HLA 1-8, 2-12 or 3-7 was compared with all other two-antigen matches within the group. Improved graft survival, occurred with HLA 1-8 matches (85% and 80% at 2 and 5 years, respectively) and with HLA 2-12 matches (80% at both 2 and 5 years), compared to all other two-antigen matches (71% and 58% at 2 and 5 years, respectively). Allografts matched for HLA 3-7 had poorer graft survival (44% at both 2 and 5 years). We compared nondiabetic and diabetic recipients and found similar improved graft survival with HLA 1-8 or 2-12 matches in nondiabetic recipients. There was no difference, however, in graft survival in diabetic recipients with HLA 1-8 or 2-12 matches, as compared to other two-antigen matches. We conclude that HLA antigen matches of 1-8 or 2-12 between donor and recipient have demonstrated improved graft survival in nondiabetic recipients, while HLA 3-7 matches have poorer survival, as compared to other two-antigen matches. Thus, unlike single antigen serotyping, selected HLA antigen matching appears to afford superior graft survival.
D000961:Antilymphocyte Serum / Q000008:administration & dosage; D001379:Azathioprine / Q000008:administration & dosage / Q000627:therapeutic use; D048909:Diabetes Complications; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000187:drug effects / Q000528:radiation effects; D006085:Graft Survival / Q000187:drug effects / Q000528:radiation effects; D006680:HLA Antigens / Q000032:analysis; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation; D008722:Methods; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors; D014184:Transplantation, Homologous
D000961:Antilymphocyte Serum; D006680:HLA Antigens; D001379:Azathioprine; D011241:Prednisone