Pretransplant Calculated Panel Reactive Antibody in the Absence of Donor-Specific Antibody and Kidney Allograft Survival

Abstract

Background and objectivesPanel reactive antibody informs the likelihood of finding an HLA-compatible donor for transplant candidates, but has historically been associated with acute rejection and allograft survival because testing methods could not exclude the presence of concomitant donor-specific antibodies. Despite new methods to exclude donor-specific antibodies, panel reactive antibody continues to be used to determine the choice of induction and maintenance immunosuppression. The study objective was to determine the clinical relevance of panel reactive antibody in the absence of donor-specific antibodies.Design, setting, participants, & measurementsRetrospective observational study of kidney allograft survival among 4058 zero HLA-A–, B-, DR-, and DQB1-mismatched transplant recipients without antibodies to donor kidney antigens encoded by these HLA gene loci.ResultsAmong 4058 first and repeat transplant recipients, patients with calculated panel reactive antibody (cPRA) 1%–97% were not at higher risk of transplant failure, compared with patients with cPRA of 0% (death censored graft loss: hazard ratio, 1.07; 95% confidence interval, 0.82 to 1.41). Patients with cPRA ≥98% had a higher risk of graft loss from any cause including death (hazard ratio, 1.39; 95% confidence interval, 1.08 to 1.79) and death censored allograft failure (hazard ratio, 1.78; 95% confidence interval, 1.27 to 2.49). In stratified analyses, the higher risk of graft loss among patients with cPRA ≥98% was only observed among repeat, but not first, transplant recipients. In subgroup analysis, there was no association between cPRA and graft loss among living related transplant recipients.ConclusionsCalculated panel reactive antibody is poorly associated with post-transplant immune reactivity to the allograft in the absence of donor-specific antibody.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_01_25_CJN13640820_final.mp3

Use and Outcomes of Induction Therapy in Well-Matched Kidney Transplant Recipients

“…In this regard, PRA has commonly been used as a laboratory measure of immune risk. The association of induction therapy with transplant outcomes in this study was consistent in patient subgroups defined by cPRA, in keeping with recent findings indicating that cPRA is not associated with transplant outcomes in the absence of DSA (26 –28).…”

Parati̇roi̇t Nakli̇ Bekleyen Hi̇poparati̇roi̇di̇ Hastalarinin Naki̇l Bekleme Süreleri̇ni̇n Değerlendi̇ri̇lmesi̇

“…Ek olarak, paratiroit naklinde immün baskılayıcı ilaçların kullanımı kısıtlı ve kısa sürelidir (5,21). Böbrek ve akciğer nakillerinde alıcının ret riskini öngörmede kullanılan testlerden biri olan PRA seviyesi, paratiroit naklinde de ayrıca değerlendirilmektedir (22)(23)(24). Bu nedenle paratiroit nakli bekleyen listesindeki PRA seviyesi yüksek olan hastalar birimimizde ayrı bir grup olarak takip edilmektedir.…”