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Matching for the HLA-A and -B antigens was found to have a significant influence on the outcome of 459 cadaveric first transplants, with a difference in graft survival of 21% at one year between best and worst matched grafts (p = 0.003). Matching for the HLA-DR antigens seemed to have an even greater influence. In a material of 226 prospectively typed transplants, a difference in graft survival of 35% at one year between best and worst matched transplants was found (p = 0.03). In the HLA-DR matched transplants there was no significant effect of matching for the HLA-A and -B antigens. An effect of pre-transplant blood transfusions was possibly seen only in DR mismatched transplants, but the effect was not statistically significant. The results indicate that major emphasis should be placed on obtaining HLA-DR compatibility in renal transplantation.
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