Which HLA loci should be matched

As shown in Table 93.3, matching for many of the HLA loci has been reported to be important in affecting transplant outcome, and there has been general consensus that mismatches for HLA-A, -B, and -DR loci are important. Studies using DNA typing methods have demonstrated the importance of matching for HLA-C in MUD transplants.104-106,108,109,123 Thus, matching for HLA-A, -B, -Cw, and DRB1* is supported by numerous studies. Conflicting results have been reported regarding the importance of matching for HLA-DQ and -DP (Table 93.3). In some cases, the effect of mismatch was observed when coupled with mismatches at other loci but not in isolation. The effect of mismatches at DRB3", DRB4*, and DRB5* (secondary DRB) has not been evaluated. It can be argued that all of these loci should be matched between patient and donor if possible since products of all of these alleles can elicit T-cell responses.124 125 Because of strong linkage disequilibrium between DRB1* and DQ and the secondary DRB loci, matching can generally be accomplished. However, since linkage disequilibrium between DRB1* and DP is much lower, otherwise very well matched donors are frequently mismatched at DP. If included in a matching algorithm, some centers may use HLA-DP matching to distinguish among otherwise matched donors.

rable 93.3 Effect of HLA matching on unrelated donor :ransplant outcome
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