The HLA-matching effect in different cohorts of kidney transplant recipients.
1. The HLA-matching effect in Type 1 diabetic patients applied only to those receiving a kidney alone. Those receiving simultaneous pancreas transplants did not benefit significantly from HLA-matching, although graft survival was high. Nevertheless, an HLA-matching effect could be shown for grafts from cadaver donors who were 25-35 years of age. Grafts from older donors apparently were more vulnerable to diabetic complications. The highest graft survival in diabetic patients was obtained with HLA-identical living donor grafts-60% at 10 years, which was in marked contrast to the 35% survival rate of HLA-mismatched cadaver donor grafts. 2. Functional graft survival analysis (censoring deaths) of Type 1 diabetics showed that graft survival was low because of deaths, presumably resulting from diabetic complications. 3. The HLA-matching effect was modest for focal glomerulonephritis patients. However, a small HLA-matching effect was noted in retransplants from cadaver donors and grafts from living donors. 4. Patients with polycystic kidney disease had the highest overall graft survival rates in all HLA-mismatch categories. Zero-ABDR-mismatched first cadaver transplants had a 60% ten-year survival rate and a 78% survival rate from HLA-identical living donors. 5. Patient survival in all the disease groups was not affected by HLA matching. Graft failure and return to dialysis apparently did not affect survival of patients. 6. Overall graft survival rates have improved markedly with newer immunosuppressants and improved patient care. The 3-year graft survival rate for the worst mismatches improved from 67% in 1987-90 to 73% for 1990-92 transplants to 73% for 1992-94, 78% for 1994-96, and 80% for transplants performed in 1996-98. 7. Projected 10-year graft survival for patients transplanted since 1994 was 64% for 0-HLA-mismatched grafts and 47% for 5-6 antigen-mismatched transplants--a 17% differential. Thus, despite newer immunosuppression, HLA matching continues to be an important factor.
Terasaki
P I
PI
D000328:Adult; D002102:Cadaver; D002648:Child; D015331:Cohort Studies; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D012042:Registries; D012086:Reoperation; D014019:Tissue Donors; D014481:United States