The DRw6 Phenomenon in Renal Transplantation
During the first 10 years, the selection of potential recipients of cadaveric renal grafts in Eurotransplant was based primarily on ABO-compatibility and matching for the HLA-A and HLA-B locus determinants (1). The beneficial effect of HLA-A and -B matching on kidney graft survival was strongest in male recipients lacking bloodgroup O (2). HLA-A and -B matching did not only improve long term graft survival but also patient survival (3), probably due to a lower amount of corticosteroids given during the first postoperative months (4). However, 5 years after transplantation, over 40% of poorly matched grafts (those with ≥ 2 A/B mismatches) are still functioning. These recipients seem to be low responders against foreign transplantation antigens present in the graft. Another explanation may be that these patients belong to the so-called corticosteroid-sensitive group in which renal graft prognosis is good (5). Nevertheless, one should avoid, if possible, a high number of HLA-A and -B mismatches because there is one report that recipients with long term survival of poorly matched grafts appear to be in a high risk group with respect to the evetual development of malignancies (6).
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