Survival of DNA HLA-DR typed and matched cadaver kidney transplants. The Collaborative Transplant Study.
The clinical value of serological HLA matching for cadaver kidney transplantation remains uncertain because the success rate for HLA-matched cadaver transplants is lower than that of HLA-matched sibling grafts. Up to 25% of serological HLA-DR typings may be incorrect when compared with a more accurate DNA-RFLP method, and we have now examined whether incorrect HLA-DR typings account for the lower than expected success rates of HLA-matched cadaver transplants. 58 transplant centres took part in this study and DNA was extracted from over 4000 samples of frozen tissue at the study centre. 8 laboratories then completed blind RFLP typing for HLA-DR. Serological typing data were reported by individual transplant laboratories. 29 of 107 transplants (27%) that were reported as HLA A, B, DR compatible and 76 of 273 (28%) transplants that were reported as HLA B, DR compatible according to serological typing were found to be HLA-DR mismatched by DNA typing. The one-year transplant success rate for DNA-matched HLA, A, B, DR grafts was 87% compared with 69% for mismatched grafts (p less than 0.02); the corresponding success rate for DNA-matched HLA B, DR grafts was 85% compared with 72% for mismatched grafts (p less than 0.01). Many transplants that were previously thought to be HLA matched are mismatched, and this finding may account for previously unexplained graft failures.
Department of Transplantation Immunology, University of Heidelberg, Germany.
G
G
Opelz
J
J
Mytilineos
S
S
Scherer
H
H
Dunckley
J
J
Trejaut
J
J
Chapman
D
D
Middleton
D
D
Savage
O
O
Fischer
J D
JD
Bignon
D002102:Cadaver; D004247:DNA / Q000032:analysis*; D005069:Evaluation Studies as Topic; D006085:Graft Survival / Q000235:genetics*; D006684:HLA-DR Antigens / Q000235:genetics*; D015798:HLA-DR1 Antigen / Q000235:genetics*; D006650:Histocompatibility Testing / Q000592:standards*; D006801:Humans; D016030:Kidney Transplantation; D012150:Polymorphism, Restriction Fragment Length; D012189:Retrospective Studies
D006684:HLA-DR Antigens; D015798:HLA-DR1 Antigen; C043263:HLA-DRw10; D004247:DNA