Survival of Nationally Shared, HLA-Matched Kidney Transplants

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Abstract
Takemoto et al. (Sept. 17 issue)1 report a 9 percent improvement in one-year graft survival and a doubling of the estimated half-life for cadaveric renal allografts matched for six antigens, as compared with HLA-mismatched allografts. However, in their analysis of risk factors for graft failure, the effect of using ABO-compatible but mismatched grafts (organs from donors with type O blood were used in recipients with type A, B, or AB blood; organs from donors with type A or B blood were used in recipients with type AB blood) was not studied. The possible adverse effects of using ABO-compatible but mismatched renal allografts include decreased graft survival and hemolysis due to anti-ABO antibodies produced by primed lymphocytes within the donor organ. Thus, Gordon et al. have reported decreased survival for liver allografts transplanted into ABO-compatible but mismatched recipients2. Hemolytic reactions have also been reported in ABO-mismatched recipients of liver3 and renal4 allografts.