Pretransplant virtual PRA and long-term outcomes of kidney transplant recipients

Lu Huber, Nils Lachmann, Matthias Niemann, Marcel Naik, Lutz Liefeldt, Petra Glander, Danilo Schmidt, Fabian Halleck, Johannes Waiser, Susanne Brakemeier, Hans H. Neumayer, Constanze Schönemann, Klemens Budde

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17 Scopus citations

Abstract

Virtual panel-reactive antibodies (vPRA) have been implemented to gauge sensitization worldwide. It is unclear how it associates with long-term outcomes, and its correlation with peak (pPRA) or actual (aPRA) has not been studied. We retrospectively reviewed data from 18- to 65-year-old kidney-only transplant patients during 1.1.1996-31.7.2011 in our center. PRAs were calculated based on solid-phase techniques. Of the 726 qualified cases, regardless of the PRA type, sensitized patients (PRA > 5%) had more females and previous transplant. Highly sensitized (HS, PRA > 50%) had longer waiting time, lower transplant rate, less living donor, more delayed graft function, and acute rejection. The conformity between vPRA and pPRA in HS was 75%, 57% between pPRA and aPRA. Forty-three percent (61/142) patients whose pPRA was >5% had no detectable aPRA and maintained similar outcomes as sensitized patients. Multivariate analysis showed consistently lower death-censored graft survival in HS defined by vPRA [HR 2.086 (95% CI 1.078-4.037), P < 0.05] and pPRA [HR 2.139 (95% CI 1.024-4.487), P < 0.05]. Both vPRA and pPRA provided reliable way estimating sensitization and predicting long-term graft survival, while aPRA might underestimate true sensitization. vPRA might be the most objective parameter to gauge sensitization.

Original languageEnglish (US)
Pages (from-to)710-719
Number of pages10
JournalTransplant International
Volume28
Issue number6
DOIs
StatePublished - Jan 1 2015

Keywords

  • graft survival
  • panel-reactive antibodies
  • sensitization
  • virtual PRA

ASJC Scopus subject areas

  • Transplantation

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    Huber, L., Lachmann, N., Niemann, M., Naik, M., Liefeldt, L., Glander, P., Schmidt, D., Halleck, F., Waiser, J., Brakemeier, S., Neumayer, H. H., Schönemann, C., & Budde, K. (2015). Pretransplant virtual PRA and long-term outcomes of kidney transplant recipients. Transplant International, 28(6), 710-719. https://doi.org/10.1111/tri.12533