LA Matching for Kidney Transplantation

c r c s p r d l g t c e t s t A p m s t i i NTRODUCTION istocompatibility testing is an essential component of a uccessful kidney transplant program for two fundamenal reasons. First, human leukocyte antigens (HLA) play central role in the cellular and humoral immune reponses that determine the outcome of a transplant. econd, the extensive polymorphism of HLA poses a ajor barrier to successful transplantation. The role of LA matching in renal transplantation is evolving as dvances in immunology increase our understanding of he structure and function of HLA and as improvements n technology have enhanced our ability to distinguish LA antigens and the antibodies reactive to them. ransplant success rates have increased markedly because f the development of better immunosuppression treatents for controlling the immune responses that lead to ransplant failure. We now know that the benefit of HLA atching varies depending on donor and recipient risk actors. There are definite differences in the distribution f HLA alleles among various ethnic populations; thereore, allocation schemes weighted heavily for HLA comatibility will favor distribution to Caucasian recipients ecause the majority of deceased organ donors are Cauasian. Many argue that current immunosuppression regmens obviate the benefits of HLA matching altogether, aising the question of whether HLA matching should be sed in allocation. In this article, we review potential ffects of HLA on transplant immunity (summarized in able 1), HLA matching protocols for kidney transplanation (Table 2), confounding factors for HLA matching Table 3), and allocation issues (Table 4). Recommendaions for HLA matching are provided after the concluion.