Abstract: Objective To explore the impact of killer cell immunoglobulin-like receptor (KIR) gene mismatch on the outcomes of
renal transplantation. Methods We collected the data from 111 donor-recipient pairs of kidney transplant and analyzed the
status of KIR gene matching, acute rejection (AR), and 1-year and 3-year survival of the recipients who were followed
continuously for over 37 months. Results Seventeen KIR genes were expressed in both recipient and donor groups, and the
frequency of KIR3DS1 was significantly higher in the recipients than in the donors (38.75% vs 24.66%, OR=2.17, χ2=3.94, P<
0.05). The average rate of donor-recipient KIR matching was 82.53% . The donor-recipient KIR2DS1 matching rate was
significantly higher in AR group than in no-AR group (85.00% vs 54.95%, χ2=6.19, P<0.05). The rate of donor-recipient KIR
AB-AB genotype was significantly higher in AR group than in no-AR group (33.33% vs 8.00%, P<0.05). The 1- and 3-year
survival rates was 94.59% and 82.88% in these recipients, respectively. The frequency of donor KIR-AB genotpye was
significantly higher in recipients with poor outcomes (57.89% vs 29.63%, χ2=8.19, P<0.05); the frequency of both donor and
recipient KIR-AB genotype was also significantly higher in recipients with poor prognoses (36.84% vs 9.78%, χ2=14.87, P<0.05).
Conclusions KIR3DS1 may be the susceptible gene associated with uremia. A KIR-AB genotype of either the donor or the
recipient can increase the risk of AR and reduce the 1- and 3-year survival rate. This finding can be of ethically importance in
choosing a living related donor.