Why HLA matching not required before transplantation of skin and heart?

Munish - You ask an excellent question. As a cardiologist, I can tell you about heart transplantation, but I don't know much about skin transplantation. As you point out, HLA matching is not routinely done for heart transplants, but there is a growing number of cardiologists who argue that it SHOULD be done.

One of the arguments against HLA matching in heart tranplants is that it is not practical in the limited time available before viability of the heart starts to suffer. However, as technology improves, this argument may become less valid.

Another argument is that as our immunosuppressive drugs improve, HLA matching becomes less important because the improvement in graft (i.e. the transplanted heart) survival will be small and will not justify the added expense of a widespread HLA typing/matching program. However, studies do show that the better the match, the better the outcome.

So stay tuned, because medicine is a constantly changing field. A few years from now, someone else might be asking why we go through the trouble of HLA matching before heart transplantation! Hope that helps!