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.
Opelz
G
G
Department of Transplantation Immunology, University of Heidelberg, Germany.
Mytilineos
J
J
Scherer
S
S
Dunckley
H
H
Trejaut
J
J
Chapman
J
J
Middleton
D
D
Savage
D
D
Fischer
O
O
Bignon
J D
JD
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