Long-term results with forty-five living related renal allograft recipients genotypically identical for HLA.

During the past decade 45 living related renal allografts have been performed between siblings genotypically identical for HLA. In each case all available family members were serotyped and haplotype analysis was performed. Immunosuppressive therapy consisted of standard azathioprine and prednisone regimens. Only one instance of HLA-D incompatibility was documented. HLA-A, -B haplotypes were identical in each case. Histopathological evaluation by light, immunofluorescence, and electron microscopy was completed. Four patients experienced acute cellular rejection with mild long-term impaired renal function. Five patients had acute cellular rejection but subsequently experienced long-term normal renal function. Twenty-three patients had little or no rejection documented and half of these patients are being maintained without steroid therapy. Five patients had histologically proven acute humoral rejection and, of these, three subsequently lost their allografts whereas two regained relatively normal renal function. Recurrent glomerulonephritis was documented in six cases. One was lobular, one crescentic, and one dense-deposit membranoproliferative glomerulonephritis. Three cases of IgA nephropathy were diagnosed. In each case the recurrent glomerulonephritis reflected the same histopathology and clinical course as the disease realized in the host kidneys. Eighty-seven percent of the 40 surviving patients have been rehabilitated completely and are fully employed.