Comparison of PRA-STAT, sHLA-EIA, and anti-human globulin-panel reactive antibody to identify alloreactivity in pretransplantation sera of heart transplant recipients: correlation to rejection and posttransplantation coronary artery disease.
BACKGROUND
Screening pretransplantation recipient sera for percent panel reactive antibodies (%PRA) by an anti-human globulin (AHG) assay may identify recipients who are at risk for graft rejection or development of posttransplantation coronary artery disease. However, the pretransplantation AHG-%PRA does not always correlate with the occurrence of graft rejection or coronary artery disease.


METHODS
We compared the predictive capacity of the AHG-%PRA with that of an enzyme-linked immunoassay (EIA)-based PRA assay that identifies immunoglobulin G bound to soluble human leukocyte antigen (sHLA) class I molecules from pooled platelets of 240 random donors (sHLA-EIA), and that of an EIA-based assay that detects immunoglobulin G anti-HLA class I antibodies bound to sHLA derived from individual HLA-typed cell cultures (PRA-STAT). The pretransplantation sera from 130 cardiac allograft recipients were comparatively tested and results evaluated.


RESULTS
Although AHG-%PRA- and sHLA-EIA-determined PRA results were comparable, neither assay discriminated potential recipients at risk for rejection or coronary artery disease. However, cardiac allograft recipients with pretransplantation PRA-STAT sera > 10% were at risk for (1) graft rejection (77% vs 56%, p < .05); (2) more rejections/recipient (1.9 vs 1.0, p < .02); (3) graft rejection within 30 days (92% vs 38%, p < .001); or (4) development of coronary artery disease (48% vs 23%, p < .05) than recipients with pretransplantation PRA-STAT sera < 10%.


CONCLUSIONS
PRA-STAT analysis of pretransplantation sera from potential cardiac allograft recipients may be more clinically informative about HLA alloimmunity and a better predictor of adverse clinical events than either AHG-%PRA- or sHLA-EIA-determined PRA.
Kerman
R H
RH
Department of Surgery, The University of Texas Medical School, Houston 77030, USA.
Susskind
B
B
Kerman
D
D
Lam
M
M
Gerolami
K
K
Williams
J
J
Kalish
R
R
Campbell
M
M
Katz
S
S
Van Buren
C T
CT
Frazier
H
H
Radovancevic
B
B
Fife
S
S
Kahan
B
B
D000918:Antibody Specificity; D003327:Coronary Disease / Q000209:etiology*; D004797:Enzyme-Linked Immunosorbent Assay; D006084:Graft Rejection / Q000175:diagnosis*; D006085:Graft Survival; D016027:Heart Transplantation / Q000276:immunology*; D015395:Histocompatibility Antigens Class I / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D012307:Risk Factors; D005719:gamma-Globulins / Q000276:immunology*
D015395:Histocompatibility Antigens Class I; D007518:Isoantibodies; D005719:gamma-Globulins