[The modern potential of histocompatibility in clinical kidney transplantation]

To many clinicians, the improvement of cadaveric kidney graft survival, achieved in the last decade, has become a reason to reconsider the importance of HLA matching in renal transplantation under modem conditions. Nevertheless, there still are arguments to continue selecting donors on the basis of HLA compatibility. Single-center cadaveric renal transplantation data were used to calculate graft survival rates by Kaplan-Meyer analysis and to create the Cox model of the probability of seven-year transplanted kidney survival. One-year and seven-year survival rates for 362 cadaveric kidneys transplanted in 1996-2004 were 83.1% and 60.7%, respectively. One-factor analysis found five factors--HLA-DR compatibility, common HLA epitope compatibility, HLA-DQl compatibility, the replacement of Azathyoprine with Cellsept, and donor's age--to have significant effect on transplant survival rate. All these factors were used as variables in a highly significant (p < 0.00001) multifactor Cox model of graft survival. The summary influence of histocompatibility factors on renal graft survival was found to be as high as 86% compared to 6% related to Cellsept and 8% related to donor's age. These results show that histocompatibility is still the main factor favoring the survival of cadaveric renal allograft.