HLA matching effect: better survival rates and graft quality.

1. HLA matching remains a major factor in kidney transplantation. Much of the total graft failures can be eliminated through better HLA matching. 2. Very early effects of HLA matching can be seen with the requirement of dialysis within one week. 3. Even among kidneys which are functioning at the beginning of each period, more frequent rejection treatment with increasing numbers of A,B,DR mismatches was observed. 4. Among functioning kidneys, HLA matching affects the quality of kidney function, as reflected in the serum creatinine levels during all periods. 5. Immunological graft failures (regardless of cause) are strongly associated with HLA mismatching. 6. The effect of HLA matching was similar at centers with high or low overall graft survival rates. 7. The fraction of zero-A,B,DR mismatches has increased dramatically in recent years. However, this is a large difference in the numbers between centers and OPOs. 8. Preformed cytotoxic antibodies to HLA tend to force a higher degree of matching for the A and B loci, resulting from T-lymphocyte crossmatching. 9. Because of the linkage of the 3 HLA loci (A, B, and DR), matching for one often results in matching for 2 or 3 of the loci. 10. Chronic glomerulonephritis patients having DR1 had superior graft survival rates than patients without DR1. 11. HLA frequencies in IDDM, hypertensive nephropathy, CGN and PC were significantly different from controls in many Class II specificities and some Class I specificities.