Towards kidney allocation on basis of HLA-DR compatibility.

In the past years immunosuppressive regiments were mainly directed against T cell reactivity. Recently, alloreactivity by B cells and HLA antibodies have received more attention often triggered by the proposal of Terasaki on the "humoral theory of transplantation". Alloantibodies are not only a relevant factor before transplantation, but are also a cause of allograft dysfunction after transplantation. In the present report we advocate the possibility to reduce the effect of these detrimental, donor specific antibodies in organ transplantation. We propose to introduce fully HLA-DR compatibility in renal transplantation to increase the possibility of the patient to receive an adequately matched organ leading to an increased graft survival. This procedure is associated with a lower degree of allosensitization towards the donor HLA antigens and in case of graft failure, a higher chance to be retransplanted. This step can be seen as the first in a series of possibilities to diminish allosensitization without the need of additional immunosuppressive treatments.