Impact of Pre-Transplant PRA Level On Renal Graft Survival in Patients With Negative Cross-Match and No Donor Specific Antibody.

Abstract

Purpose: The aim of this study was to investigate the impact of pre-transplant PRA level on rejection and graft survival after kidney transplantation in patients with negative cross-match(CXM(-)) and no donor specific antibody(DSA(-)). Method: We analyzed retrospectively 513 kidney recipients transplanted at our center. And among them, those who identified positive test on cross-match, those who had donor specific antibodies, ABO incompatible, and those who had no information of PRA were excluded(n=130). The factors included peak PRA, age, gender, HLA mismatch number, transplant number, donor source, rejection were reviewed. Peak PRA was stratified into 3 groups according to their PRA levels group I, PRA=0; group II, PRA 0< ≤50%, and group III, PRA 50%<. Graft failure was defined as return to dialysis, transplant nephrectomy, or death with functioning kidney. Results: The mean follow up duration was 29.4±14.6month(0-59). The rejection rate was 20.1%(group I 18.5%(n=58) vs. group II 23.8%(n=10) vs. group III 33.3%(n=9) (p=0.053)). The graft failure rate was 21.7%(group I 6.4%(n=20) vs. group II 7.1%(n=3) vs. group III 7.4%(n=7)(p=.792))Table: No Caption available.Univariate analysis by log-rank test, donor source and rejection were significantly associated with graft survival(p=.000 and .000, respectively), however subcatergories of PRA were not(p=.851). On multivariate Cox regression analysis, donor source and rejection were also significantly associated with graft survival(p=0.002 and 0.000, respectively), however including subcatergories of PRA(p=.552), other variables were not significant. Conclusion: The rejection rate was higher as PRA group increasing, however it was not statistically significant(p=.053). Pre-transplant PRA value was not significantly associated with graft survival, in patients with CXM(-) and DSA(-). However, donor source and presence of rejection were significantly associated with graft failure.