INFLUENCE OF HLA MATCHING ON KIDNEY GRAFT -SURVIVAL IN RELATION TO THE RECIPIENTS AGE

Donor-recipient histocompatibility, as evaluated by the HLA matching r esults, plays an important role in the outcome of renal transplants, a lthough much controversy surrounds the benefit of kidney allocation ba sed on HLA typing. In this report HLA matching and survival data on 1, 342 transplants performed at the University of California at San Franc isco between 1984 and 1992 and treated uniformly by quadruple immunosu ppression were analyzed in relation to the recipient's age. With respe ct to the influence of the increasing number of mismatches from 0 to 6 , the analysis revealed decreasing 3-year graft survival rates as foll ows: 85.4%; 87.3%; 71.3%; 78.2%; 75.8%; 70.9% and 67.5%. Whereas the i mpact of cold ischemia time and histocompatibility was equally importa nt during the 3-year postoperative period, the essential positive infl uence of good HLA matching on the long-term graft survival was demonst rated. The children aged between 5 and 18 years were identified as a h igh-risk group by the analysis, HLA-A incompatibility being attributed to poor graft survival in this age group. With respect to the effect of HLA-A histoincompatibility, the data provide evidence that HLA-A ma tching results seem to play an important role in graft survival in chi ldren, whereas transplants well matched in terms of HLA-B did well in adult recipients. No age difference in the impact of HLA-DR could be d etected. In conclusion, HLA matching is still essential. It seems that there are differences in the impact of HLA loci in relation to the re cipient's age.