As an extension of our first observation in which the peripheral blood lymphocytes of an aplastic amaemia patient with a transplant were able to show HLA-restricted H-Y killing in a cell-mediated lympholysis assay, we report here a second case showing exactly the same phenomenon.Α multitransfused woman suffering from aplastic anaemia was shown to have in vitro killing after priming her lymphocytes with her HLA-identical brother. This killing was directed to all male target cells carrying the HLA-A2 antigen. Marginally, killing was also directed to some HLA-A2 female target cells, but this was at a considerably lower level than that directed to male cells. The level of HLA-restricted H-Y killing declined with time. However, it was possible to reactivate the H-Y specific killing by in vitro Stimulation with lymphocytes from an HLA-A, -B, and -C-identical, but HLA-D-different male donor. That these findings could be relevant for renal transplantation was supported by renal allograft survival data obtained at 2 years after transplantation. Male allografts from HLA-A2-positive donors in A2-positive females survived for a significantly shorter time than non-A2 male kidneys in non-A2 female recipients. This was only apparent in recipients who produced antileukocyte antibodies.
Different influences on corneal survival were studied in 539 grafts. The follow-up period ranged from 3 months to 4 1/2 years. The degree of vascularization of the host cornea, previous graft failures and the diameter of the graft could be demonstrated to influence the graft survival significantly. A significant influence of sex differences between donors and recipients was found. A female donor results in a better graft survival in female recipient as compared to male recipients. No significant influence on graft survival was found of pregnancies and blood transfusions. Age of the donor, storage methods and time lapse between death and transplantation did not influence the graft survival either.
Data on the effect of HLA-A and HLA-B matching between unrelated donors and recipients focus mainly on graft survival. After linking the follow-up data of the European Dialysis and Transplant Association and those of the Eurotransplant Foundation, the effect of HLA-A and HLA-B matching on recipient survival could be studied. Recipients of well-matched kidneys--i.e., without mismatches for the HLA-A and B antigens--had 51 per cent graft survival at five years, whereas recipients of grafts mismatched for four antigens had 32 per cent graft survival at five years. The overall P value between the five different mismatch classes was 0.0005. Patient survival at five years was 72 per cent in recipients of a kidney without HLA-A and B mismatches and 54 per cent in recipients of a completely mismatched donor kidney (overall, P = 0.001). These results suggest that matching for the HLA antigens has a beneficial long-term effect not only on renal-allograft survival but also on patient survival.
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