title: 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.
abstract: 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.
authors.affiliation: Department of Surgery, The University of Texas Medical School, Houston 77030, USA.
authors.forename: R H
authors.initials: RH
authors.lastname: Kerman
authors.forename: B
authors.initials: B
authors.lastname: Susskind
authors.forename: D
authors.initials: D
authors.lastname: Kerman
authors.forename: M
authors.initials: M
authors.lastname: Lam
authors.forename: K
authors.initials: K
authors.lastname: Gerolami
authors.forename: J
authors.initials: J
authors.lastname: Williams
authors.forename: R
authors.initials: R
authors.lastname: Kalish
authors.forename: M
authors.initials: M
authors.lastname: Campbell
authors.forename: S
authors.initials: S
authors.lastname: Katz
authors.forename: C T
authors.initials: CT
authors.lastname: Van Buren
authors.forename: H
authors.initials: H
authors.lastname: Frazier
authors.forename: B
authors.initials: B
authors.lastname: Radovancevic
authors.forename: S
authors.initials: S
authors.lastname: Fife
authors.forename: B
authors.initials: B
authors.lastname: Kahan
mesh_terms: 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*
chemical_list: D015395:Histocompatibility Antigens Class I; D007518:Isoantibodies; D005719:gamma-Globulins