HLA MATCHING IN PEDIATRIC RECIPIENTS OF A FIRST KIDNEY GRAFT

We retrospectively examined the effect of HLA-A, -B, and -DR serologic al matching on graft survival in 88 pediatric end-stage renal disease patients who underwent primary renal transplantation. Actuarial graft survivals (GS) at 2 and 6 years in patients with zero DR mismatches (M M) (12 patients) or 1 DR MM (58 patients) were significantly higher th an those in patients with 2 DR MM (18 patients) (2-year GS: 100% vs. 9 0% vs. 59%; 6-year GS: 100% vs.79% vs. 59%, respectively), Because of the low number of patients in the zero DR MM group, only the GS differ ence between 1 DR MM and 2 DR MM had a significant result at 1 year (9 2% vs. 68%). No clear HLA matching effect was obtained in the HLA-A an d -B loci, When DR were combined with A or B antigens (0-2 MM vs, 3-4 MM), significantly higher GS at 1, 2, and 6 years persisted for patien ts with 0-2 MM only in the A, DR group (96%, 94%, and 85% vs, 68%, 63% , and 56%, respectively). It is suggested that avoidance of mismatchin g for DR alleles at the serological level, in the selection of pediatr ic recipients of first cadaveric renal transplantation, leads to an im provement of both short- and long-term graft outcome.