title: The impact of HLA mismatches on the survival of first cadaveric kidney transplants.
abstract: BACKGROUND
  The benefits of HLA-A, B, and DR matching of cadaveric kidney grafts and recipients remain controversial when viewed from the perspective of social equity and graft survival.
  
  
  METHODS
  We estimated graft survival using proportional-hazards techniques, adjusting for patient and donor characteristics, for a series of 30,564 Medicare patients receiving a first cadaveric kidney transplant between 1984 and 1990. The effects of minimal achievable HLA mismatches and maximal matching on graft survival were estimated by simulated allocation of a sample of organs to a sample of 20,000 candidates for transplantation.
  
  
  RESULTS
  The adjusted one-year graft survival was 84.3 percent for grafts with no mismatches and 77.0 percent for grafts with four mismatches. National rationing of donor organs to achieve minimal mismatching and maximal matching could potentially decrease the average number of HLA mismatches from 3.6 to 1.2, with a corresponding increase in the number of matches. As a consequence, projected five-year graft survival could potentially increase from 58.5 percent to 62.9 percent. This would be associated with a decrease in the proportion of kidneys allocated to black recipients from 22.2 to 15.0 percent.
  
  
  CONCLUSIONS
  Under ideal circumstances, a policy of maximal matching of cadaveric renal transplants would increase five-year graft survival by a comparatively small 4.4 percentage points, but the actual benefit is likely to be smaller.
authors.affiliation: Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor 48103.
authors.forename: P J
authors.initials: PJ
authors.lastname: Held
authors.forename: B D
authors.initials: BD
authors.lastname: Kahan
authors.forename: L G
authors.initials: LG
authors.lastname: Hunsicker
authors.forename: D
authors.initials: D
authors.lastname: Liska
authors.forename: R A
authors.initials: RA
authors.lastname: Wolfe
authors.forename: F K
authors.initials: FK
authors.lastname: Port
authors.forename: D S
authors.initials: DS
authors.lastname: Gaylin
authors.forename: J R
authors.initials: JR
authors.lastname: Garcia
authors.forename: L Y
authors.initials: LY
authors.lastname: Agodoa
authors.forename: H
authors.initials: H
authors.lastname: Krakauer
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People; D002648:Child; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000032:analysis*; D006648:Histocompatibility; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis
chemical_list: D006680:HLA Antigens