Use of panel reactive antibodies for immunological risk stratification and its correlation with antecedent events in live donor kidney transplant: A prospective single-center study

Abstract

Background: Panel reactive antibody (PRA) is a screening test to identify the immunological sensitization of the transplant recipients. The current study focuses on the role of PRA in immunological risk stratification in live donor kidney transplant and its correlation with antecedent events and posttransplant outcomes. Methods: This was a prospective, single-center, observational study. All patients with end-stage renal disease between January 1, 2016, and October 1, 2016, were included. The patient's sensitization history and other immunological workup were recorded. Patients were followed up for 6 months. Results: PRA positivity was seen in 29/185 (15.7%) patients. Female sex (P = 0.004), longer duration renal replacement therapy (P = 0.037), and hepatitis C virus infection positivity (P = 0.047) were significantly associated with PRA positivity. Only 3/87 (3.4%) patients who had no history of sensitizing events had high PRA. Less number of patients in PRA-positive group received transplant as compared to PRA-negative group (12/29; [41.4%] vs. 143/156 [91.7%, P < 0.0001]). In transplanted patients, there was no significant difference between PRA-positive and PRA-negative group in terms of serum creatinine (1.22 ± 0.26 mg/dl vs. 1.30 ± 0.38 mg/dl, P = 0.63) and number of acute rejection (1 vs. 6, P = 0.507). Conclusions: PRA positivity is not uncommon in live donor kidney-transplant patients. Previous transplants, pregnancies, and multiple blood transfusions are important sensitizing events. PRA testing was useful in identifying high-risk patients and evaluating them further. There was no difference in short term outcomes between PRA-positive and PRA-negative groups after exclusion of high-risk patients from transplantation.