In deceased donor kidney transplantation, which HLA mismatch has the greatest adverse impact on long-term graft survival and is prioritised in allocation?
- A HLA-A
- B HLA-B
- C HLA-DR ✓
- D HLA-C
Correct answer: C. HLA-DR
Explanation
Mismatch at the HLA-DR locus has the strongest association with rejection and reduced graft survival, because class II molecules drive direct allorecognition and CD4 helper T-cell activation, which amplifies both cellular and humoral responses. Allocation systems therefore weight DR matching most heavily, followed by B and then A. HLA-C mismatching contributes little to graft outcome and is not part of standard allocation scoring in kidney transplantation.
Reference: Schwartz Principles of Surgery, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.