HLA-A, B and DR antigens in renal transplantation. A further report on the Northwestern and MEDUNSA experience.
HLA histocompatibility antigens form part of the basis of immune reactions in transplant immunology. However, controversy surrounds their use in renal allograft organ sharing. Selected HLA-related studies in the transplant programmes of Northwestern Memorial Hospital (NWMH), Chicago, USA, and the Medical University of Southern Africa (MEDUNSA), Pretoria, are presented. In the Northwestern Memorial Hospital experience with 27 recipients of O-mismatches, 48% were mixed leucocyte culture (MLC) compatible (% relative response < 25). Actuarial graft survival rates at yearly intervals up to 5 years were 100%, 100%, 85%, 75%, 75%, compared with 75%, 65%, 65%, 55% and 55% in compatible and incompatible groups, respectively (Breslow P = 0.05 and Mantel-Cox P = 0.11). Creatinine values at yearly intervals up to 5 years were significantly better in the MLC-compatible group (Mann-Whitney U-test P < 0.05). In the MEDUNSA experience with 85 black recipients of poorly HLA-matched renal allografts of the same donor race, actuarial graft survival at yearly intervals up to 5 years was 73%, 68%, 61%, 61% and 57%. The commonest HLA-A, B and DR antigens at MEDUNSA are A30, A9, A2, A10, A28; B17, B12, B42, B8; DR3, DR5 and DR4 (in this order of frequency). The NWMH experience illustrates that HLA-matching improves renal allograft survival in O-mismatches. At MEDUNSA, however, satisfactory results are obtained using kidneys harvested from black donors.
Modiba
M C
MC
Department of Surgery, Medical University of Southern Africa, Pretoria.
Ngcobo
T K
TK
Wolf
J S
JS
Morse
R
R
Du Toit
E D
ED
D000328:Adult; D044383:Black People; D002102:Cadaver; D005260:Female; D006085:Graft Survival / Q000276:immunology*; D015234:HLA-A Antigens / Q000276:immunology*; D015235:HLA-B Antigens / Q000276:immunology*; D006684:HLA-DR Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007087:Illinois; D016030:Kidney Transplantation / Q000276:immunology*; D007959:Lymphocyte Culture Test, Mixed; D008297:Male; D008875:Middle Aged; D013019:South Africa; D001741:Black or African American
D015234:HLA-A Antigens; D015235:HLA-B Antigens; D006684:HLA-DR Antigens