Probability of deceased donor kidney transplantation based on % PRA
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文摘
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 ¡À 3.8 times with different donors to receive KT). The mean PRA for the whole group was 22 ¡À 32 % , median [md] 0 (0-98). A total of 100 patients received KT (mean waiting time 2.2 ¡À 1.7 years, 12 days-7 years) and their mean % PRA was 11.6 ¡À 24, md 0 (0-94) vs. 31.4 ¡À 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 % .

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