The influence of transplant nephrectomy on panel reactive antibodies (PRA) directed against HLA antigens: A pilot report

Abstract

Rationale Antibodies reactive with allogenic HLA antigens may be produced as a result of sensitization to previous transplant and can influence the outcome of a subsequent transplant. The literature pertaining to the influence of transplant nephrectomy on panel reactive antibodies is scant. Therefore a pilot study was initiated. Methods The study included 6 patients who underwent renal transplant nephrectomy at the Transplant Institute of New Orleans. Panel reactive antibodies were measured in the peripheral blood sample using complement dependent cytotoxicity (CDC-AHG) and ELISA. Results In 3 of the 6 patients, the PRA pre-transplant and post-nephrectomy were 0%. In one of these 3, the nephrectomy was performed 2 weeks post-transplant and the graft loss was non-immunologic suggesting lack of sensitization. In another patient, the transplant lasted 13 years before it failed suggesting tolerized graft, hence a PRA of 0%. In the remaining 3 patients, the PRA increased from 0% pre-transplant to 95%, 97%, 82% following transplant nephrectomy. The donor directed antibody specificity included A1; A2,28 and B13 respectively. Conclusions The results suggest that in some patients panel reactive antibodies directed against donor HLA antigens may increase following transplant nephrectomy. These observations may have clinical implications. A larger prospective investigation is desirable to confirm these observations.