Success rate and impact of HLA matching on kidney graft survival in highly immunized recipients. Collaborative Transplant Study.

From 1985 to 1990, 225 highly immunized recipients were transplanted based on a program of serum exchange and priority allocation of kidneys to crossmatch negative recipients. The 1-year graft survival rate in first transplant recipients was 73% and in second transplant recipients, 71%. Recipients of third or fourth transplants had a 25% lower success rate. HLA matching exerted a significant influence on graft outcome. Twenty-five first or second grafts with zero mismatches for HLA-B,-DR had a 91% 1-year survival rate, in contrast to a 58% survival rate of 38 grafts with of three or four HLA-B,-DR mismatches (log rank P < 0.001).