The effectiveness of HLA testing prior to kidney transplantation in improving graft quality and patient survival

Abstract

Title: The effectiveness of HLA testing prior to kidney transplantation in improving graft quality and patient survival. Objective: Tissue typing for Human Leukocyte Antigens (HLA) is a significant cross-match test that identifies the compatibility between antigens of those of a prospective kidney donor and of a kidney transplant recipient. Presently, HLA-testing in Malta is only performed prior to kidney transplantations with living prospective donors and not for deceased donors, as the length of time to obtain the result from this test would make kidney preservation impossible. The purpose of this study was to explore whether HLA-tissue typing exhibits a positive effect on graft and patient survival following kidney transplantation. Research Question: In renal transplant recipients, is tissue typing for Human Leukocyte Antigens associated with a better quality of graft and patient survival? Method: Various databases were utilised for a comprehensive literature search including those found at the University of Malta e-library. The search included studies in the English language that involved the Caucasian race and adult participants. They involved comparison in outcomes between matched and mismatched kidney transplants with the HLA -A, -B and -DR molecules. The outcome involved twelve cohort studies, critically appraised with the CASP tool for cohort studies. Results: Overall, the results of the literature revealed that HLA-testing had a beneficial effect on graft and patient survival. Conclusion: The positive outcomes necessitate the introduction of HLA testing for transplantations with deceased prospective donors. This enlightened the need for obtaining more rapid results, which should be accompanied by an efficient kidney allocation process. The latter would involve a well-managed transplant waiting list consisting of a ranking scheme, which would be inputted into a computerised database so that all activity and outcomes would be monitored.