Long-term follow-up in London Transplant Group recipients of cadaver renal allografts. The influence of HLA matching on transplant outcome.

The London Transplant Group followed 1341 patients with cadaver renal transplants, none of whom received cyclosporine, for six months to 14 years to determine the effect on graft survival of matching donor and recipient for HLA Class I antigens (HLA-A, -B, and -C) and Class II antigens (HLA-DR, -MT, and -DQ). Long-term graft survival was greatly improved by matching for HLA Class I antigens, especially HLA-B. Transplants that could not be matched for both B-locus antigens but were completely matched for Bw4/Bw6 also did very well. In addition, since 1978, excellent results have been obtained with HLA-DR and -DRw52/53 (HLA-MT) matching, but not with HLA-DQ matching. Multivariate analysis using the Cox regression model confirmed that combination Class I and Class II matching produced significant improvements in graft survival. Thus, transplants matched for HLA-DR plus HLA-B and those matched for HLA-MT plus HLA-B had excellent results--even better than those reported with cyclosporine treatment. Double HLA-MT incompatibilities yielded the poorest results. We conclude that this approach of combining the broad and narrow specificities of Class I and II is extremely practical and that appropriate matching of tissue types is clinically important.