Improved renal allograft survival with selected HLA antigen matching.

We examined the influence of the three most frequent linkage disequilibrium antigen combinations, HLA 1-8, 2-12, and 3-7, on renal allograft survival. We reviewed the results of 214 first transplants to recipients sharing exactly two HLA-A or -B antigens with the donor, excluding failures caused by hyperacute rejection or technical factors. Actuarial graft survival for matches having HLA 1-8, 2-12 or 3-7 was compared with all other two-antigen matches within the group. Improved graft survival, occurred with HLA 1-8 matches (85% and 80% at 2 and 5 years, respectively) and with HLA 2-12 matches (80% at both 2 and 5 years), compared to all other two-antigen matches (71% and 58% at 2 and 5 years, respectively). Allografts matched for HLA 3-7 had poorer graft survival (44% at both 2 and 5 years). We compared nondiabetic and diabetic recipients and found similar improved graft survival with HLA 1-8 or 2-12 matches in nondiabetic recipients. There was no difference, however, in graft survival in diabetic recipients with HLA 1-8 or 2-12 matches, as compared to other two-antigen matches. We conclude that HLA antigen matches of 1-8 or 2-12 between donor and recipient have demonstrated improved graft survival in nondiabetic recipients, while HLA 3-7 matches have poorer survival, as compared to other two-antigen matches. Thus, unlike single antigen serotyping, selected HLA antigen matching appears to afford superior graft survival.