The benefit of HLA-matching in kidney transplantation

A successful kidney transplant is the most effective treatment for patients with end-stage renal insufficiency, and provides the best chance of good long term rehabilitation while restoring the quality of life of the patient. When undertaking these procedures the transplant physician will aim for the best possible degree of tissue compatibility between the donor and the recipient. This has always been the ground rule in the allocation of cadaveric donor organs. However, a perfect tissue match (fully identical HLA-A+B+DR antigens, or a zero HLA-mismatch) can be achieved only for a minority of the patients. In particular those patients who have become highly immunized (usually because of a previous transplant), or patients with a rare HLA-phenotype, are difficult to match and therefore seem condemned to excessively long periods on the waiting list. Mainly because of the very success of kidney transplantation, the number of patients on the waiting list has grown tremendously during the past decades, and this has resulted in a corresponding increase of the mean waiting time. In order to continue to achieve good outcomes and acceptable waiting times for the majority of patients, it is crucial to have access to an (international) pool of patients and donors, and to exchange available donor organs. This notion laid the foundation for Eurotransplant and other similar organ sharing organizations.