HLA matching effect on five-year graft survival and half-life in the cyclosporine era

From 1984 to 1990, a 6 to 10% increase in one-year graft survival was noted for patients matched or mismatched for HLA A, B, or DR locus antigens. This improvement was not attributable to matching. In the cyclosporine era, five-year graft survival of 0-ABDR mismatched first cadaver donor transplants was 61% in contrast to 45% survival for the worst 6-antigen mismatched grafts. The long-term half-life of 0-ABDR mismatched grafts was 10.7 years, compared with 6.4 years for the 6-antigen mismatched transplants. The cumulative survival years (a measure of impact) were twice as high for 0-ADR, 0-BDR and 0-AB mismatched grafts compared with 0-ABDR mismatches. On the basis of cumulative survival, five-year survival, and half-life, one might suggest sharing kidneys for 1-2 ABDR mismatch, 1 BDR, 1-2 AB mismatch, and 1-ADR mismatch. Young patients (5 to 25 years old) had lower graft survival rates when receiving poorly mismatched grafts. HLA matching did not influence graft survival in Black recipients, whose half-lives were 3.8 to 4.6 years for all matching categories.