INFLUENCE OF HLA MATCHING ON REJECTIONS AND SHORT-TERM AND LONG-TERM PRIMARY CADAVERIC ALLOGRAFT SURVIVAL

Distribution of cadaveric donor kidneys, based upon the donor-recipien t HLA match grade, remains one of the major controversies in transplan tation. To determine whether matching results in fewer rejection episo des and better graft survival, we retrospectively studied our single-c enter patient population of 683 cyclosporine-prednisone-treated primar y cadaveric renal allograft recipients. For 237 recipients of well-mat ched HLA A, B kidneys (less than or equal to 2 HLA A, B mismatches [MM ]) the 1-, 3-, 5-, and 7-year graft survivals of 76%, 66%, 62%, and 61 %, respectively, were not significantly different from those of 71%, 6 5%, 63%, and 63%, respectively, for the 446 poorly matched HLA A, B (> 2 HLA A, B MM) recipients. Similarly, the 1-, 3-, 5-, and 7-year graft survivals for the 307 recipients of well-matched HLA-DR kidneys (0 or 1 DR MM) of 74%, 65%, 63%, and 61%, respectively, were not significan tly different from those of 72%, 65%, 63%, and 62%, respectively, for the 366 poorly matched (2 DR MM) recipients. Patient survivals were co mparable at each time point for well- vs. poorly matched recipients. S imilarly, donor-recipient HLA A, B, and DR matching was not beneficial in retransplant recipients who were transplanted following negative N IH and antiglobulin (AHG) crossmatches when testing both historical (h igh-PRA) and pretransplant sera. Since rejection episodes may be a mor e sensitive indicator of immune response than graft loss, we also anal yzed the relationship between donor-recipient HLA match grade and post transplant rejections. A total of 60% (n=413) of recipients experience d no rejections and had 1-, 3-, 5-, and 7-year graft survivals of 82%, 78%, 74%, and 73%, respectively; 32% (n=215) of patients who experien ced 1 rejection had 1-, 3-, 5-, and 7-year graft survivals of 58%, 48% , 44%, and 43%, respectively (P<0.001 for graft survival of 0 vs. 1 re jection). The remaining 8% (n=55) of recipients experienced more than 1 (>1) rejection and had 1-, 3-, 5-, and 7-year graft survivals of 62% , 38%, 36%, and 36%, respectively (P<0.001 for graft survival of 0 vs. >1 rejection and P<0.01 for graft survival of 1 vs. >1 rejection). Th e mean numbers of rejections/patient experienced by well-matched vs. p oorly matched recipients were comparable and not significantly differe nt. Finally, while no differences were observed for the graft survival s of the 254 untransfused vs. the 401 transfused recipients, transfuse d recipients did experience significantly (P<0.01) fewer rejections th an untransfused recipients. Therefore, our data do not support the not ion that HLA A, B, and DR donor-recipient matching impacts graft survi val or rejection.