Strength of HLA-A, HLA-B, and HLA-DR mismatches in relation to short- and long-term kidney graft survival

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Abstract
The separate influence of HLA‐A, HLA‐B, and HLA‐DR mismatches on short‐ and long‐term kidney graft survival was analyzed in a series of over 40,000 recipients of first cadaver kidney transplants. As expected, during the early posttransplant period, HLA‐DR mismatches had a stronger influence on graft survival than HLA‐B mismatches, and HLA‐A mismatches had a very small influence. Surprisingly, during the period from 6 months to 5 years post transplantation, all three HLA loci had approximately the same influence. When the graft survival computation was started at 100 % at 6 months, the difference between grafts with zero or two mismatches at the end of 5 years was 6 %, regardless of whether HLA‐A, HLA‐B, or HLA‐DR antigens were analyzed. The influence of the three loci was additive so that the survival rate difference between transplants with zero or six mismatches for HLA‐A, ‐B, ‐DR was 17 % at 5 years. We concluded that, although the HLA‐A locus exerts only a weak influence during the early posttransplant course, its influence on long‐term survival is comparable to that of HLA‐B and HLA‐DR. In order to obtain optimal long‐term survival, all three loci must be considered in the donor‐recipient matching procedure.