ANALYSIS OF HLA-DR SPLIT-SPECIFICITY MATCHING IN CADAVER KIDNEY-TRANSPLANTATION - A REPORT OF THE COLLABORATIVE TRANSPLANT STUDY

The influence of mismatches for HLA-DR ''split'' specificities was inv estigated in more than 8000 cadaver kidney transplants. HLA-DR typing was performed using DNA methodology. Among first transplants, mismatch es defined by HLA-DR split specificities did not have a deleterious in fluence. Among retransplants, however, graft survival was significantl y decreased if a mismatch was defined, considering split specificities in patients with no mismatch according to the ''broad'' definition (P =0.04) and also in grafts with two split mismatches, which showed only one mismatch according to the broad definition (P=0.03). Moreover, co nsideration of further ''subsplit'' specificities resulted in clinical ly relevant mismatches only among retransplants. These data indicate t hat the recognition of HLA-DR split specificity mismatches is fundamen tally different in primary and regraft recipients, The results imply t hat recipients and donors of kidney retransplants should be typed for HLA-DR split specificities and that these specificities should be cons idered for organ allocation.