The DRw6 Phenomenon in Renal Transplantation

Abstract

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).

This work was in part supported by the Dutch Foundation for Medical Research (FUNGO) which is subsidized by the Dutch Organization for the Advancement of Pure Research (ZWO), the J. A. Cohen Institute for Radiopathology and Radiation Protection (IRS) and the Kuratorium für Heimdialyse Neu Isenburg, Germany.