It is a rare opportunity to receive a kidney transplant at a time when there is an acute shortage of donor kidneys.
When presented with this precious opportunity, many uremic patients struggle:
Does it matter if this kidney matches mine?
Match result“Bad” still can do kidney transplant operation?
Can We wait for the results of the match before we do the transplant?
During the spring season, Dr. Wang would like to have a chat with you about the above questions:
What is HLA and HLA matching
Let’s talk about what HLA is and HLA matching.
The full name of HLA is“Human leukocyte antigen”, which can reflect the immune compatibility between two individuals. In organ transplantation, it is the degree of acceptance of the transplanted organ by the patient.
In addition to identical twins whose HLA is identical, almost no two people’s HLA is identical and can therefore be regarded as an individual’s“Identity card”. After surgery, the transplanted organ will not be rejected even if no immunosuppressive drug is taken.
However, because there are many loci on HLA and some loci have little effect on renal allograft rejection, only a few important loci are usually detected clinically.
Since each individual received one set of chromosomes from each parent, clinical tests were performed for three loci on each set of chromosomes, HLA-A, HLA-B, and HLA-DR, and the two sets of chromosomes were six loci.
Relationship between HLA matching and renal allograft rejection
HLA is an important factor in determining the risk of kidney transplant rejection. The more HLA loci the donor and recipient match, the lower the risk of kidney transplant rejection, the longer-term survival rate of the transplanted kidney is higher. Because identical twins have identical HLA, the transplanted organ would not have been rejected even if the immunosuppressive drug had not been taken.
Because there are many factors that can affect renal allograft rejection and its long-term survival rate, such as insufficient immunosuppressive drug dose, toxic injury of immunosuppressive drug, viral infection of the kidney, and recurrence of renal allograft glomerulonephritis, hLA matching does not play a significant role in the long-term survival of kidney transplants.
HLA matching and the sequence of kidney transplantation
Since HLA matching is also a factor in the long-term outcome of kidney transplants, why is it that sometimes kidney transplants are performed before the results are known?
In living relative kidney transplantation, due to adequate preparation time, it is indeed possible to perform kidney transplantation after the HLA matching results are available. However, in post-death donation (DCD) kidney transplantation, due to the limited preparation time, it is difficult to wait until the HLA matching results are available in order to reduce the cold ischemia time of the transplanted kidney. In addition, HLA matching results are not required for kidney transplantation, so in many cases HLA matching results are obtained after kidney transplantation.
Relationship between blood group, HLA matching and renal transplantation
Dr. Wang often uses this loose analogy to illustrate the relationship between blood type, HLA matching and kidney transplantation:
A kidney transplant is like two people getting married, blood type is like gender, HLA matching is like looks, and the long-term survival of a kidney transplant is like the duration of marriage. As long as gender (Blood Type) does not conflict, ugly or beautiful (HLA matching results) , does not affect the ability to get married (kidney transplant) . There are a number of factors that affect how long a marriage lasts (kidney transplant survival) , and a better-looking spouse (HLA match) is likely to last longer. Kidney transplants with incompatible blood types are now well established, just as two people with conflicting genders can get married, so gender (Blood Type) is no longer a barrier to marriage (kidney transplant) .
By Wang Zinna
