Goeken N E, Thompson J S, Corry R J
Transplantation. 1981 Dec;32(6):522-7. doi: 10.1097/00007890-198112000-00015.
In a 2-year trial at a single center, prospective HLA-DR matching for cadaver renal transplantation exerted a stronger effect than either HLA-A and B matching or blood transfusion. One-year cumulative graft survivals for two-DR-matched organs was 92%. Grafts matched for one DR antigen had a cumulative 1-year graft survival of 65% whereas grafts matched for zero DR antigens had a cumulative 1-year survival of 41%. When all cadavers with less than two identifiable DR antigens were excluded from this analysis, however, the graft survivals of the groups known to be mismatched for one or two DR antigens were similar (61% versus 59%). Grafts matched for three or four HLA-A and B antigens did somewhat better than those matched for only zero, one, or two HLA A and B antigens (74% versus 59%, 1-year survival). This effect was only demonstrable in the zero- and one-DR-matched group. Similarly, prior blood transfusion exerted a modest effect (transfused versus nontransfused, 71% versus 56% 1-year graft survival) that was also most evident in the zero- and one-DR-matched groups. The institution of this trial was also associated with a 35% annual increase in the rate of transplantation and a 50% reduction in median patient waiting time. DR typing of cadaveric donors is feasible and highly desirable. Multicenter pooling of DR-typed donors is thus predicted to lead to optimal matching for a high proportion of renal transplant candidates.
在一个单一中心进行的为期两年的试验中，尸体肾移植中前瞻性HLA - DR配型比HLA - A和B配型或输血产生的效果更强。两个DR位点匹配的器官1年累积移植存活率为92%。一个DR抗原匹配的移植物1年累积移植存活率为65%，而零个DR抗原匹配的移植物1年累积存活率为41%。然而，当将所有可识别的DR抗原少于两个的尸体排除在该分析之外时，已知一个或两个DR抗原错配组的移植物存活率相似（61%对59%）。三个或四个HLA - A和B抗原匹配的移植物比仅零个、一个或两个HLA - A和B抗原匹配的移植物表现稍好（1年存活率分别为74%对59%）。这种效果仅在零个和一个DR位点匹配组中明显。同样，既往输血也有一定作用（输血组与未输血组，1年移植存活率分别为71%对56%），这在零个和一个DR位点匹配组中也最为明显。该试验机构还使移植率每年提高35%，患者中位等待时间缩短50%。尸体供者的DR分型是可行且非常必要的。因此，预计多中心汇集DR分型的供者将使高比例的肾移植候选者实现最佳配型。
