The influence of HLA-A,B and -DR matching and pregraft blood transfusions on graft and patient survival after renal transplantation in a single centre.

The influence of HLA-A,B and DR matching and pregraft blood transfusions on the graft and patient survival rate of 305 recipients of first cadaver grafts in a single centre has been studied. All three factors significantly influenced the graft survival rate. The effect of HLA-A,B matching became apparent only after a follow-up period of 3 years whereas the effect of HLA-DR matching was seen within 3 months after transplantation. The survival rate of HLA-DR compatible grafts was not improved by additional HLA-A,B matching, but that of HLA-DR mismatched grafts was improved by HLA-A,B matching. The HLA-DR matching effect was seen in both transfused and in nontransfused patients. However, the highest graft survival rate seen was in the pregraft transfused patients who received a DR compatible kidney (87% at 1 year and 80% at 5 years). Both HLA-A,B and DR matching significantly increased the patient survival rate whereas blood transfusion did not. The lower survival rate of patients receiving HLA poorly-matched grafts was not related to the amount of methylprednisolone received during the first 3 months after transplantation, the age of the patient, or whether the patient was considered medically high risk at the time of transplantation.