In the past decade, great progress has been achieved in improving patient outcome following kidney transplantation. Patient mortality and morbidity have been greatly reduced with more specific and more limited immunosuppression regimens for the treatment of acute rejection.1 Excellent graft survival has also been predicted and obtained for patients who received kidneys from related HLA identical or 1-haplotype鈥�-matched donors with low reactivity in the mixed lymphocyte cultures (MLCs).2 The majority of renal transplants, however, have used cadaver donor kidneys either because of the lack of available related donors or nonutilization of related donors because of high MLC reactivity between donor and recipient. Since graft survival rates in the patients with high MLCs are similar to those obtained with cadaveric transplantation,2,3 several newer techniques and approaches have been introduced to improve graft survival in these groups. Better donor-recipient matching through HLA DR typing and more specific immunosuppression with