Cicciarelli J, Terasaki P I, Mickey M R
Transplantation. 1987 May;43(5):636-40. doi: 10.1097/00007890-198705000-00006.
The effect of HLA matching on one-year first cadaver donor graft survival rates between best and worst matches was 6% (P less than 0.001) for A, B; 7% (P less than 0.001) for DR; 9% (P less than 0.001) for A, DR; 15% (P less than 0.001) for B, DR; and 17% (P less than 0.001) for A, B, DR. For second cadaver donor grafts, the differences were comparable. Analysis of the cyclosporine-treated patients separately yielded similar results: 5% (NS) for A, B; 7% (P less than 0.001) for DR; 13% (P less than 0.001) for A, DR; 16% (P less than 0.001) for B, DR; and 18% (P less than 0.001) for A, B, DR. The most significant effect of matching was achieved by zero mismatching B and DR antigens. The one-year graft survival for patients with zero A, B, DR mismatch was 88% with cyclosporine. Without cyclosporine, zero mismatched A, B, DR grafts survive at 84%; this difference is not statistically significant. Zero mismatching for class I and II antigens (that is, A, DR or B, DR with cyclosporine) gives one-year graft survivals of 84% and 87%, respectively. The zero mismatching HLA class I and II antigen effect is lost when even one antigen is mismatched. Transfusions improved the one-year graft survival 10% in cyclosporine-treated patients, but not in those who were not treated with cyclosporine. Seventy-one patients transfused with more than 4 units of blood, zero B, DR mismatched, and treated with cyclosporine had a 91% one-year graft survival. Recipient pool sizes for obtaining zero A, B, DR or B, DR mismatched donors are calculated. Zero A, B, DR mismatched patients can be transplanted at a 19% frequency with a 10,000 recipient pool. The success rate for zero mismatching of class I and class II antigens indicates that kidney sharing and large recipient pool sizes are a reasonable policy.
HLA配型对首次尸体供肾移植1年存活率的影响：在最佳配型与最差配型之间，A、B位点配型的影响为6%（P<0.001）；DR位点为7%（P<0.001）；A、DR位点为9%（P<0.001）；B、DR位点为15%（P<0.001）；A、B、DR位点为17%（P<0.001）。对于第二次尸体供肾移植，差异相似。单独分析接受环孢素治疗的患者也得到类似结果：A、B位点为5%（无统计学意义）；DR位点为7%（P<0.001）；A、DR位点为13%（P<0.001）；B、DR位点为16%（P<0.001）；A、B、DR位点为18%（P<0.001）。B和DR抗原零错配时配型效果最为显著。A、B、DR抗原零错配的患者接受环孢素治疗时1年移植肾存活率为88%。未使用环孢素时，A、B、DR抗原零错配的移植肾存活率为84%；此差异无统计学意义。I类和II类抗原零错配（即使用环孢素时A、DR或B、DR零错配）的1年移植肾存活率分别为84%和87%。只要有一个抗原错配，HLA I类和II类抗原零错配的效果就会丧失。输血使接受环孢素治疗的患者1年移植肾存活率提高了10%，但未接受环孢素治疗的患者未出现这种情况。71例输注超过4单位血液、B、DR抗原零错配且接受环孢素治疗的患者1年移植肾存活率为91%。计算了获得A、B、DR或B、DR抗原零错配供者的受者库大小。A、B、DR抗原零错配的患者在受者库为10000例时移植频率可达19%。I类和II类抗原零错配的成功率表明，肾脏共享和较大的受者库规模是一项合理的策略。
