Effets favorables de certaines incompatibilités HLA-DR sur la survie de l'allogreffe rénale. Proposition en faveur d'une nouvelle politique de sélection des receveurs.

: In a previous retrospective study conducted from 1980 to 1987 on 275 renal cadaveric transplants, we have shown that HLA-DR disparities between donor and recipient exerted differential effects on graft survival. Thus, the presence of DR4, DR5 and DR7 in the donor, or of DR5 in the recipient was associated with an excellent survival, whereas disparities due to the presence of DR1 and DR2 in the donor, or of DR2, DRw6 and DR7 in the recipient were detrimental for the graft. A prospective study on 158 renal cadaveric transplants performed from 1988 to 1990 yielded results that were similar to those of the retrospective study. Graft survival at 18 months was similar in recipients who had either the same DR antigens as those present in their donor or beneficial DR disparities only (83-90 percent), and significantly higher than in recipients with DR detrimental disparities only (62-65 percent). Graft survival in recipients with either mixed or neutral DR disparities occupied an intermediate position (77-78 percent). In conclusion, grafts with excellent outcome, similar to that observed in DR identical pairs, may be proposed to an ever increasing number of patients awaiting a renal transplant by adopting a selection policy based on the choice of beneficial DR disparities when a DR identical recipient is not available in the pool.