HLA‐DQ matching in cadaveric renal transplantation

Abstract

The impact of matching for the human leukocyte antigen (HLA)‐ DQ phenotype in cadaveric renal transplantation is unclear. We analyzed the effect of matching serologically defined HLA‐DQ phenotypes on renal allograft survival in 12,050 first cadaveric renal transplants (recipients were 63.5% white and 36.5% African‐American). Recipients were entered into the South‐Eastern Organ Procurement Foundation (SEOPF) database between 1 October 1987 and 6 June 1995. A series of life table analyses were done to test the equality of survival curves for HLA‐DQ match, both alone and accommodating for differences in recipient race and HLA‐DR match. Cox regression models were then performed to detect differences in allograft survival based upon HLA‐DQ match. Initial adjustments were done by recipient race. Subsequent adjustments were done by recipient and donor race, age and sex, cold ischemia time (CIT), body mass index (BMI), cyclosporine A (CyA) use, peak panel reactive antibody (PRA) titer, year of transplant, presence of diabetes mellitus (DM), and degree of HLA‐A,B and HLA‐DR match as covariates. The effect of varying degrees of HLADQ match on graft survival were similar between the two races (p=0.87). In all recipients, an 8.3% reduction in graft failure was observed for each increase in HLA‐DQ match using the Cox regression model adjusted only for recipient race (p=0.004). A non‐significant 3.0% reduction in graft failure (p=0.38) was observed for each level of increasing HLA‐DQ match when using the Cox regression model adjusted for recipient and donor race, age and sex, CIT, BMI, CyA use, year of transplant, DM, HLA‐A,B and ‐DR match. In this model, superior HLA‐A,B match and HLA‐DR match, recipient and donor age, male donor sex, shorter CIT, white race of recipient, lower peak PRA, CyA use, and absence of DM significantly improved graft survival (all ≤0.004). We conclude that HLA‐DQ matching does not significantly affect cadaveric renal allograft survival once adjusted for other known predictors of graft outcome.