The significant effect of HLA-DRBl matching on acute rejection in kidney transplants

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Abstract
The object of the present study was to confirm the HLA‐DRBI matching effect on rejection crisis, its severity, and kidney graft survival based on genotyping. Ninety‐four renal allografts were included in this study. DNA typing of HLA‐DRBI was performed by the polymerase chain reaction sequence‐specific oligonucleotide method. The incidence of acute rejection within 6 months following transplantation, the frequency of OK administration for steroid‐resistant rejection, histopathological findings, and graft survival rate were compared between the DR ‐matched (n = 23) and DR ‐mismatched (n = 71) groups. Four acute rejections occurred in the DR ‐matched group (incidence; 17 %) and 40 in the DR ‐mismatched group (56 %). In the DR ‐matched group, the incidence of acute rejection was significantly less frequent than that of the DR ‐mismatched group (P < 0.005). In the DRBI‐matched group, only one patient received OK administration (4 %), in contrast to 16 of 71 patients in the DR ‐mismatched group (23 %). The use of OK was significantly less frequent in the DR ‐matched group (P < 0.05). Histopathological findings from biopsy specimens showed no constant distribution of pathological grades of acute rejection according to DRBI matching in the present study. The graft survival rate in the two groups did not differ significantly, but the graft survival rate in the DR ‐mismatched group had a tendency to decrease as the grafts survived longer. In conclusion, the results of the present study confirm that HLA‐DR matching has marked beneficial effects on kidney transplants through reduction of the acute rejection rate and decrease of the severity of rejection, and suggest that improvement of graft survival will be obtained through kidney allocation to a DR ‐matched recipient.