Background: HLA mismatches, especially those at the HLA-DR locus, are reported to influence allograft survival. In this single center study the effect of HLA-DR matching on graft survival, patient survival and episodes of rejection was analyzed and compared in highly sensitized patients.

Methods: Single center retrospective analysis of 1103 recipients of deceased donor kidney transplantation from 1/1/2000- 12/31/2010 was performed. FlowPRA, Flow and /or Luminex single antigen bead assays, and flow crossmatches with donor lymphocytes were performed pre-transplant. Patients were transplanted only when the prospective crossmatch was negative. Patients were divided into 3 groups based on level of HLA-DR matching, namely Group 1(0 DR match, n= 374), Group 2 (1 DR match, n=525) and Group 3 (2 DR match, n=204). The groups were further analyzed and compared by PRA (≤ 19 and ≥ 80). Kaplan Meier analysis was used to assess patient and graft survival.

Results: No significant difference (p>0.05) in long-term graft and patient survival was observed among the 3 groups. These results held true when highly sensitized patients (PRA ≥ 80) were compared with lowly sensitized patients (PRA ≤ 19) among various DR matches. There was no significant difference (p>0.05) in the rate of antibody-mediated rejection among the 3 patient groups. However, patients in Group 1 (0 DR match) had significantly more episodes of T cell mediated rejection compared to patients in Groups 2 and 3.

Conclusions: HLA-DR matching does not appear to influence graft and patient survival up to 11 years post-transplant as graft and patient survival were essentially identical among patients transplanted with donors with whom they shared none, 1 or 2 HLA-DR antigens. Our data suggest that the absence of DSA at the time of transplant and not level of DR matching is a more critical indicator of long term graft outcome in highly sensitized patients.

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