Twenty-year follow-up on the effect of HLA matching on kidney transplant survival and prediction of future twenty-year survival.
The difficulty in achieving long-term survival is demonstrated by the fact that an improvement of 30 percentage points in 1-year cadaver donor survival resulted in only a 10-percentage point improvement over 20 years. In early transplants from 1965 to 1974, the 20-year survival rate of HLA identical siblings was 46%, of parental donors 27%, and of cadaver donors 12%. More recent grafts, performed since 1987, had a projected survival of 57% for identical donors, 30% for parental donors, and 18% for cadaver donors. With respect to HLA matching for cadaver donor kidney transplants, a 0 AB-antigen mismatch produced higher graft survival than did mismatched transplants during the 20-year period from 1965 to 1984. After the introduction of HLA Class II typing in 1980 and general improvements in typing for transplants performed after 1987, the 0 ABDR-mismatched grafts have a projected 20-year survival of 40%. The projected survival rates for transplants with one or more mismatches fall progressively to 13% for transplants that have 6 ABDR mismatches. Thus, the success due to HLA matching has improved ever since the introduction of cyclosporine because of the concurrent improvements in tissue typing for Class I and Class II specificities.
Terasaki
P I
PI
UCLA Tissue Typing Laboratory 90024, USA.
Cho
Y
Y
Takemoto
S
S
Cecka
M
M
Gjertson
D
D
D000017:ABO Blood-Group System; D000367:Age Factors; D002102:Cadaver; D016572:Cyclosporine / Q000627:therapeutic use; D005500:Follow-Up Studies; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality*; D008875:Middle Aged; D009679:Nuclear Family; D010290:Parents; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D016572:Cyclosporine