HLA-DR typing and B cell cross-match tests in cadaveric renal transplantation.

Prospective HLA-DR typing and B cell cross-match tests were performed in 177 cadaveric transplants using a modified NIH technique, 24 selected HLA-DR typing sera and B cells separated from peripheral blood in recipients and from spleen in donors. Actuarial graft survival after one year was 60% in HLA-DR compatible transplants and 30% and 18% in transplants mis-matched for 1 and 2 HLA-DR antigens. The favorable prognostic influence of HLA-DR compatibility was observed both among HLA-A, -B compatible and incompatible transplants. Sharing of HLA-DR antigen(s) between donor and recipient was also prognostically beneficial. Standard cross-match tests were negative in all transplants. B cell cross-match tests were positive in 17 cases, and one of these transplants was very acutely rejected. Actuarial graft survival after three months was 35% in B cell cross-match positive grafts versus 53% in negative ones.