HLA-DRB1 COMPATIBILITY IN CADAVER KIDNEY-TRANSPLANTATION - CORRELATION WITH GRAFT-SURVIVAL AND FUNCTION

The introduction of genomic HLA-DR typing has stimulated a re-evaluati on of the role of HLA-DR compatibility on cadaver kidney transplantati on. We retrospectively studied the influence of HLA-DRB1 matching on t he survival of 416 patients using univariate and Cox regression analys is as well as its influence on the occurrence of rejection episodes an d on creatinine level at the 3rd month in the 198 recipients for whom these data were available. The following parameters were also consider ed: HLA-A,B compatibility, donor and recipient age, graft number, pret ransplant blood transfusions and panel reactive antibodies (PRA). Twen ty-four month graft survival was 100 % for transplants with zero misma tches (n = 47), 87.9 % for those with one mismatch (n = 191) and 81.3 % for those with two mismatches (n = 178). In the Cox model, HLA-DRB1 matching was the most significant variable influencing graft survival (47 % of chi(2) P = 0.001), followed by HLA-A,B matching (23 %, P = 0. 02) and donor age (19 %, P = 0.04). Ninety-two percent of the patients with zero mismatches experienced no rejection episodes in the first 3 posttransplant months compared with 62 % and 41 % of patients with on e and two mismatches, respectively. Mean creatinine level (mg/dl) was 1.2, 1.4, and 1.5 in patients with zero, one, and two mismatches, resp ectively. Should these results be confirmed by prospective studies, HL A-DRB1 compatibility will have to be considered as an organ allocation criterion.