THE EFFECT OF HLA-A, -B MATCHING ON CADAVER RENAL ALLOGRAFT REJECTION COMPARING PUBLIC AND PRIVATE SPECIFICITIES

Abstract

Data collected prospectively on 3811 cadaver renal transplants performed between June 1977-July 1982 by the 42 member institutions of the South-Eastern Organ Procurement Foundation (SEOPF) [USA] were analyzed to determine whether donor-recipient compatibility based on public rather than private HLA-A, -B specificities influenced the beneficial effect of HLA matching on outcome. HLA compatibility was calculated considering match and mismatch based on common private or various public (crossreactive group, [CREG]) specificities. Donor-recipient compatibility using certain CREG assignments provided an equivalent means of stratifying graft outcome by the degree of HLA-A, -B match or mismatch; other CREG assignments did not. Multivariate Cox regression analysis of donor-recipient compatibility based on certain public antigens showed as high an association (P < 10-5) between good matching and decreased graft rejection as did matching for private antigens alone. Patient stratification by HLA match provided a stronger association with graft outcome than by HLA mismatch, irrespective of whether private or public antigens were considered. The likelihood of finding a better match was significantly increased using CREG assignment; patients with at least 1 matched private antigen had equivalent or better graft survival when additional public antigens were matched. With conventional immunosuppressive therapy matching of private or public HLA-A, -B antigens apparently plays a highly significant role in decreasing renal allograft rejection; matching based on certain public antigens can provide the same or a better association with outcome as private antigens. The association (crossreactivity) of various HLA specificities can be defined on a functional basis in terms of graft survival.