HLA matching in the new millennium

Despite increasing graft survival rates associated with advances in immunosuppression, the relative risk of graft loss for transplants with HLA mismatches has remained at about 25% higher than those with 0 ABDR-mismatches. The percentage of 0 DR-mismatched transplants peaked at 25% in 1994 and has decreased yearly to 15% in 2003. The percentage of transplants with a flow crossmatch increased from 5% in 1988 to 38% in 2003. Prior to 1995, a flow crossmatch was associated with a decreased risk of graft loss. Antigen distributions of HLA-A, -B, -DR and CREGs are summarized and reveal many differences between Whites and Blacks. HLA matching models with 9, 18 and 36 CREGs are presented. The more complex models yielded fewer cases but outcomes approached that achieved for 0 ABDR-mismatched transplanted.