目的　研究人类白细胞Ⅱ类抗原 (HLA DR)基因相容对肾移植长期存活的影响。方法　采用基因分型技术 ,回顾性分析 5 18例首次肾移植HLA DR基因相容情况。结果　单个移植中心达到基因水平DR相配的受者超过 10 % ,半数以上可达 1个DR相配。HLA DR相容的受者急性排斥反应显著减少、早期肾功能恢复顺利 ,1～ 5年人存活率提高 10 %～ 2 1.7% (P <0 .0 5 )、肾存活率提高 17%～ 37.7% (P <0 .0 1) ,差异有显著性。Cox模型独立分析表明 ,DR错配是影响移植肾长期存活的主要因素之一。结论　选择基因水平HLA DR相容具有临床可行性、对首次尸肾移植长期存活具有显著影响。 Objective To study the effect of HLA DR gene compatibility on the long-term survival of renal allograft. Methods The genotyping technique was used to analyze the HLA DR gene compatibility in 518 primary renal transplant recipients. Results In a single transplant center, more than 10% of matched recipients of DR were reached, and more than half matched up to one DR. HLA DR-compatible recipients had a significant reduction of acute rejection, early recovery of renal function, 1-to 5-year survival rate increased by 10% -2 27% (P <0.05), and renal survival increased by 17% -37.7 % (P <0. 01), the difference was significant. Independent analysis of the Cox model shows that DR mismatch is one of the major factors that affect the long-term survival of transplanted kidney. Conclusion It is feasible to select compatible HLA DR level for the first time and have a significant effect on the long-term survival of the first autopsy.