Benefits of HLA-A and HLA-B Matching on Graft and Patient Outcome after Cadaveric-Donor Renal Transplantation

• Published in: The New England journal of medicine Vol. 311; no. 6; pp. 358 - 364
• Main Authors: Sanfilippo, Fred, Vaughn, William K, Spees, Everett K, Light, Jimmy A, LeFor, William M
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 09.08.1984
• Subjects: Adult; Analysis of Variance; Antigens; Bias; Biological and medical sciences; Cadaver; Cadavers; Computer terminals; Creatinine; Failure analysis; Female; Glucocorticoids; Graft rejection; Graft Survival; Histocompatibility antigen HLA; Histocompatibility Testing - methods; HLA Antigens - immunology; HLA-A Antigens; HLA-B Antigens; Humans; Immunosuppression; Kidney Transplantation; Kidneys; Laboratories; Male; Medical prognosis; Medical sciences; Patients; Printed materials; Prospective Studies; Quality control; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival; Transplantation; Transplants & implants; Human; HLA-System; Urinary system disease; Homotransplantation; Kidney; Classification
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198408093110603

Data collected prospectively on 3811 renal transplantations performed between June 1977 and July 1982 by the 42 member institutions of the South-Eastern Organ Procurement Foundation were analyzed to determine the influence of donor-recipient HLA-A and HLA-B matching on patient and graft outcome. Well-matched recipients were more likely to have received kidneys from outside their own centers, were more highly presensitized, included fewer blacks, and were more likely to have lost an earlier graft. Multivariate Cox regression analysis that included these and six other potential confounding variables revealed a significant association (P<0.001) between good HLA-A and B matching and increased graft survival. The difference in mean (±S.E.) actuarial graft survival between recipients worst matched and best matched for HLA-A and B antigens increased with time: 55±2 per cent as compared with 64±4 per cent at six months and 18±4 per cent as compared with 44±7 per cent at four years. Poor HLA matching of donor with recipient provided the greatest relative risk (2.16) of irreversible graft rejection of all the variables examined. Among patients with functioning grafts, well-matched recipients had lower serum creatinine levels and received significantly smaller amounts of glucocorticoids. Our findings indicate that good HLA-A and B matching is highly dependent on a system for sharing organs among institutions, and results in decreased graft rejection, better long-term graft function, and less need for post-transplantation immunosuppression. (N Engl J Med 1984; 311:358–64.) THE value of HLA-A and HLA-B matching in cadaveric-donor renal transplantation remains controversial, especially for heterogeneous donor and recipient populations in which organs are shared among different institutions. Several reports have indicated that matching for HLA has a beneficial effect on the survival of cadaveric allografts, 1 2 3 4 5 whereas other studies have found an effect of HLA matching to be absent or only minimal. 6 7 8 Interestingly, a recent survey of tissue-typing laboratories revealed that one third of the respondents thought that HLA-A and B matching had no effect on graft outcome. 9 In general, previous studies of HLA matching have been subject to limited . . .