HLA-A, B AND DR ANTIGENS IN RENAL-TRANSPLANTATION - A FURTHER REPORT ON THE NORTHWESTERN AND MEDUNSA EXPERIENCE

HLA histocompatibility antigens form part of the basis of immune react ions in transplant immunology. However, controversy surrounds their us e in renal allograft organ sharing. Selected HLA-related studies in th e transplant programmes of Northwestern Memorial Hospital (NWMH), Chic ago, USA, and the Medical University of Southern Africa (MEDUNSA), Pre toria, are presented. In the Northwestern Memorial Hospital experience with 27 recipients of O-mismatches, 48% were mixed leucocyte culture (MLC) compatible (% relative response < 25). Actuarial graft survival rates at yearly intervals up to 5 years were 100%, 100%, 85%, 75%, 75% , compared with 75%, 65%, 65%, 55% and 55% in compatible and incompati ble groups, respectively (Breslow P = 0,05 and Mantel-Cox P = 0, 11). Creatinine values at yearly intervals up to 5 years were significantly better in the MLC-compatible group (Mann-Whitney U-test P < 0,05). In the MEDUNSA experience with 85 black recipients of poorly HLA-matched renal allografts of the same donor race, actuarial graft survival at yearly intervals up to 5 years was 73%, 68%, 61%, 61% and 57%. The com monest HLA-A, B and DR antigens at MEDUNSA are A30, A9, A2, A10, A28; B17, B12, B42, B8; DR3, DR5 and DR4 (in this order of frequency). The NWMH experience illustrates that HLA-matching improves renal allograft survival in O-mismatches. At MEDUNSA, however, satisfactory results a re obtained using kidneys harvested from black donors.