ABSTRACT
It is well established that tissue typing and the degree of human leukocyte antigen (HLA) matching is a major predictable determinant of graft function and long-term survival following kidney transplantation. Classically, living-related donor (LRD) transplantation has several advantages as regards HLA matching, and these have been proposed as a major mechanism by which LRD transplantation provides the best long-term graft outcome, especially for HLA-identical siblings. Livingunrelated donor (LURD) transplantation, which has no HLA-matching advantage, also results in better outcomes than kidney transplantation from deceased donors, but this is due to other factors.1,2 In this chapter, we will discuss the relatively under-appreciated concept that access to donor antigen prior to transplantation is also a major advantage of living donor (LD) transplantation and that the pretransplant availability of donor cells can be exploited clinically to manipulate the subsequent immunological response to the transplanted graft.
