Elsevier

Transplant Immunology

Volume 28, Issue 4, June 2013, Pages 154-158
Transplant Immunology

Probability of deceased donor kidney transplantation based on % PRA☆☆

https://doi.org/10.1016/j.trim.2013.05.002Get rights and content
Under a Creative Commons license
open access

Highlights

  • The probability of receiving a DD KT was calculated using the % PRA (4 groups).

  • A higher risk for not receiving a KT becomes evident with a PRA > 20%.

  • % PRA is not entirely specific in regard to alloreactivity towards the donor.

  • The documented rate of AR across the % PRA groups was similar.

  • In the short run, a better graft function is observed in KTR with a PRA ≤ 20%.

Abstract

Sensitization to HLA antigens creates an obstacle for the accessibility and success of kidney transplantation (KT). Highly sensitized patients have longer waiting times and some may never receive a KT.

Aim

To determine the probability of patients on the deceased donor (DD) waiting list to receive a KT based on the panel reactive antibody percentage (% PRA) in our center.

Methods

The DD waiting list from our institution was analyzed from 01/05 to 08/12 documenting the clinical variables from donor and potential recipients (ABO blood group), lymphocyte cross-match [CxM (CDC-AHG)] results, highest % PRA determination, and time on the waiting list. The patients were classified into 4 groups based on the % PRA: 0%, 1–19%, 20–79% and 80–100%. The data was analyzed using odds ratio and logistic regression (significant p < 0.05).

Results

58 DD (F:M 34:24, ABO group O = 35, A = 13, B = 10) and 179 potential recipients were analyzed (F:M 98:81, ABO group O = 127, A = 33, B = 19, participating 4.2 ± 3.8 times with different donors to receive KT). The mean PRA for the whole group was 22 ± 32%, median [md] 0 (0–98). A total of 100 patients received KT (mean waiting time 2.2 ± 1.7 years, 12 days–7 years) and their mean % PRA was 11.6 ± 24, md 0 (0–94) vs. 31.4 ± 37 md 8.5 (0–98) in those who have not received a KT. An association between the % PRA group and KT (p < 0.003) was observed. The probability of receiving KT with a 0% PRA vs. > 0% was higher (OR 2.12, 1.17–3.84). There was no difference between the 0% vs. 1–19% group (OR 1); differences were observed between 0% vs. 20–79% (OR 2.5, 1.18–5.3) and 0% vs. 80–100% (OR 5, 1.67–14.9). For every percent increase in the PRA above 20%, the risk of not receiving a KT increased by 5% (1–9, p < 0.01).

Conclusions

The probability of receiving a DD kidney transplant is inversely related to the % PRA although a higher risk for not receiving a KT becomes evident with a PRA > 20%.

Keywords

Kidney transplant recipient
Sensitization
Panel reactive antibody
Highly sensitized
Deceased donor kidney transplantation

Cited by (0)

☆☆

This study will be presented at the American Transplant Congress in Seattle, Washington from the 18th to the 22nd of May 2013. According to the rules stated by the American Transplant Congress, the work presented at this meeting should be published only after the congress has concluded.