EFFECT OF HUMAN-LEUKOCYTE ANTIGEN MATCHING ON THE INCIDENCE OF ACUTE REJECTION IN RENAL-TRANSPLANTATION

The influence of human leucocyte antigen (HLA) matching on the inciden ce of acute rejection and graft survival was examined in 181 consecuti ve patients receiving cadaveric renal transplants. Allografts with bet ter HLA-DR and HLA-B matching showed significantly lower rejection rat es than less well matched grafts on both univariate (rejection rates 2 5, 62 and 82 per cent for zero, one and two DR mismatches; P<0.001) an d multivariate analysis. Rejection episodes occurred earlier in mismat ched grafts (P<0.001). Superior matching was associated with improved graft function at 1 year after transplantation (mean serum creatinine level 137, 180 and 225 mu mol l(-1) for zero, one and two DR mismatche s; P<0.05). No association was, however, demonstrated between the degr ee of matching and overall graft survival. Good HLA matching reduces t he number of acute rejection episodes, producing significant savings i n drug costs and hospital stay. Long-term graft function is improved a nd minimizing early graft damage helps to avoid later development of c hronic rejection.