A prospective randomized trial of matching for HLA-A and B versus HLA-DR in renal transplantation

A prospective randomized trial was performed comparing survival of cadaveric grafts allocated by HLA-A+B matching and HLA-DR matching. The two allocation methods resulted in very similar graft survivals. HLA-A matching had no significant effect on graft survival. HLA-B and HLA-DR matching were shown to have approximately equal, significant, independent, and additive effects on graft survival. Other factors that were demonstrated to have significant effects were blood transfusion, preformed antibodies, graft number, and recipient sex. The results indicate that neither allocation method alone is optimal, and that matching for HLA-B+DR is necessary. However a large pool size is necessary to obtain a high frequency of good matches.