HLA-DR and renal transplantation

Systemic immune response to peripheral nerve transplants across major histocompatibility class-I and class-II barriers

The use of peripheral nerve transplantation in limb reconstruction has been limited by tissue rejection. In order to identify the major histocompatibility antigens involved in tissue rejection, mutant strains of inbred mice, differing from the parent strain (C57BL/6) by either major histocompatibility complex Class I (B6.C-H2bml mice) or Class II (B6.C-H2bml2 mice), were used in models of nerve transplantation. One, 2, and 3 weeks after nerve or skin transplantation, the immune response in the recipient animal was monitored with use of lymphocyte-dependent cytotoxicity and complement-dependent cytotoxicity assays. Skin transplants were used for comparison as the gold standard of a nonvascularized graft with an easily observable success or failure. There was no significant cellular immune response by the lymphocyte-mediated cytotoxicity assay when nerve or skin transplants involved an isolated Class-I or Class-II mismatch, but there was a significant response 2 weeks after transplantations across a combined Class-I and Class-II barrier for nerve (p < 0.04) or skin (p < 0.03). An antibody response to the grafts occurred for both skin and nerve transplants but only when a combined barrier was involved. This preliminary study, using a mouse model, suggests that nerve transplantation-may be performed without systemic evidence of rejection with only a partial cross match of the major histocompatibility complexes, thus decreasing the complexity of tissue typing necessary for tissue banking.

HLA-A,B and DR matching in corneal transplantation

One hundred eighty-five consecutive corneal transplants were performed in recipients selected on the basis of the best available HLA-A,B and DR match. Endothelial rejection-free transplant survival in this group was compared to a retrospective historical control group of 199 consecutive transplants performed in recipients selected on the basis of age and longest wait criteria. The two groups were comparable with regards to primary diagnosis, preoperative corneal vascularization, donor and recipient age, and operative techniques. Thirty-eight transplants in the study group and 28 transplants in the control group were at high risk for endothelial transplant rejection. At 12 months, the estimated rejection-free survival (Kaplan-Meier method) of the high-risk study group transplants was 87% compared to 74% for the high-risk historical control group and transplants. This difference did not reach the significant level of 0.05 with the log-rank test. The 12-month estimated rejection-free survival of low-risk study group and historical control group transplants were similar. In the study group, the 12-month estimated rejection-free survival of well-matched transplants was 95% compared to 83% for poorly matched transplants (log rank, P less than 0.02). These findings suggest that a relationship exists between HLA-A,B and DR compatibility of donor and recipient and the corneal rejection-free transplant survival.

Organ transplantation and the immune response gene. Clinical correlations and donor requirements

Major gains have been made in the area of clinical organ transplantations due to recent studies concerning the human histocompatibility locus (HLA). These basic science findings, along with developments in clinical pharmacology have allowed for a much broader use of donor sources, and a significant prolongation in clinical life span for these transplantation recipients.