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Histocompatibility testing in transplantation.

P I Terasaki1

  • 1Department of Surgery, UCLA School of Medicine 90024.

Archives of Pathology & Laboratory Medicine
|March 1, 1991
PubMed
Summary
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Landsteiner Award. HLA epitope matching.

Transfusion·1992
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HLA matching effect on five-year graft survival and half-life in the cyclosporine era.

Kidney international. Supplement·1992
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Prolongation of second heart transplants in rats.

Transplantation·1992
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Survival of nationally shared, HLA-matched kidney transplants from cadaveric donors. The UNOS Scientific Renal Transplant Registry.

The New England journal of medicine·1992
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Effect of mismatching serologically defined residues on kidney transplant survival.

Transplantation proceedings·1992
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Beneficial effect of sharing six-antigen-matched cadaver kidneys in the United States.

Transplantation proceedings·1992

Six-antigen matching significantly improves kidney transplant outcomes. This approach enhances 1-year graft survival to 90% and extends long-term graft half-life to 19 years, demonstrating the critical role of human leukocyte antigen (HLA) matching.

Area of Science:

  • Immunogenetics
  • Transplantation immunology
  • Nephrology

Background:

  • Human Leukocyte Antigen (HLA) matching is a critical factor in organ transplantation success.
  • Previous kidney transplant outcomes have been limited by chronic rejection despite advancements in immunosuppression.
  • Cadaveric donor kidney transplant half-life has remained stagnant at approximately 7 years.

Purpose of the Study:

  • To evaluate the impact of six-antigen HLA matching on kidney transplant graft survival.
  • To assess the long-term outcomes of kidney transplantation with high levels of histocompatibility matching.
  • To determine if HLA matching can overcome limitations in current immunosuppression protocols.

Main Methods:

  • Analysis of data from a nationwide six-antigen matching program involving over 100 US transplantation centers.

Related Experiment Videos

  • Comparison of graft survival rates and long-term half-life between well-matched and mismatched kidney recipients.
  • Evaluation of survival differences across various HLA matching scenarios (identical siblings, parental donors, cadaveric donors).

    • Main Results:

    • A high 1-year graft survival rate of 88% to 90% was achieved in six-antigen matched kidney recipients.
    • Long-term graft half-life significantly improved to 19 years in six-antigen matched recipients, compared to 7 years for cadaveric donor transplants.
    • Clear survival benefit observed with increasing HLA compatibility: 25-year half-life for HLA-identical siblings, 12 years for one-haplotype mismatched parental donors, and 7 years for two-haplotype mismatched cadaveric donors.

    Conclusions:

    • Six-antigen HLA matching is definitively important for successful kidney transplantation.
    • Histocompatibility matching offers the most effective strategy for preventing chronic rejection in kidney transplants.
    • Implementing six-antigen matching programs can substantially improve both short-term and long-term kidney transplant outcomes.