The Effect of Peak and Current Serum Panel-Reactive Antibody on Graft Survival

Abstract Background Preformed antibodies against HLA antigens are known risk factors for early graft loss. Pretransplantation panel-reactive antibody (PRA) is often used to estimate the degree of sensitization. This study was conducted to determine the risk of early graft loss among subjects with a PRA cutoff value of 10%. Objectives To evaluate the influence on 1-year graft survival of pretransplant recipient sensitization using 10% peak and current PRA cutoff values. Methods From January 1988 to July 2007, T-cell and B-cell PRA data were available for 247 (41%) and 241 (40%) patients, respectively. Medical records were reviewed for graft survival, current PRA value, and peak PRA value (both T and B cell). Complement-dependent cytotoxicity (CDC) is the only method of PRA identification in this study. We analyzed the correlation between PRA level and graft survival. Results Current T-cell PRA > 10% was significantly associated with poorer 1-year graft survival when compared with those with PRA ≤ 10% in kidney transplantation from both donor sources: 48.6% versus 86.3% ( P = .007) for living donor 94.7% versus 70.0% ( P = .029) for deceased donor. Most of the graft losses in recipients with a high PRA occurred within the first 3 months posttransplantation. Conclusion In our experience, current serum T-cell CDC PRA value > 10% was significantly associated with a decreased 1-year graft survival; interventions will be required to preserved graft function in these high-risk individuals.