Effect of recipient sensitization (peak PRA) on graft outcome in haploidentical living related kidney transplants.
OBJECTIVE
To evaluate the influence of pre-transplant recipient sensitization on the outcome of 1-haploidentical live related donor (LRD) kidney transplants.


METHODS
We reviewed 141 consecutive cyclosporine-treated adult haploidentical first transplants for which panel reactive antibody (PRA) levels were available. Patients were divided into three groups according to their peak PRA levels: group I, PRA = 0 (n = 97); group II, PRA = 1-50% (n = 24); and group III, PRA = 51-100% (n = 20).


RESULTS
Differences in PRA were associated with significant differences in short- and longer-term graft survival, unrelated to patient survival. Graft survival at 1, 3, and 5 yr was only 74, 40, and 27% in group III, compared to 92, 87, and 52% in group II, and 96, 91, and 85% in group I (p < 0.001). Increasing PRA was associated with shorter time-to-graft failure. In group III, 20% lost their transplant from acute rejection in the first 6 months, versus 4% in group II and 3% in group I (p < 0.01). Graft survival in group II diverged from that of group I only after 3 yr, due to an increase in loss from chronic rejection. Hospitalization was longer in group III, in association with a significantly higher incidence of acute rejection during the first 3 months after transplantation (p < 0.02). Serum creatinine was higher in sensitized than nonsensitized patients at all time points.


CONCLUSIONS
Sensitization has a significant negative impact on the outcome of haploidentical LRD kidney transplants. Sensitized potential recipients and their potential donors should be aware of this in arriving at informed decision-making for transplantation. These patients may benefit from more sensitive cross-match testing, more intense or more novel immunosuppression, or immunomodulation to modify their immune responsiveness.
Barama
A
A
Department of Surgery, FMC, Calgary, Alberta, Canada.
Oza
U
U
Panek
R
R
Belitsky
P
P
MacDonald
A S
AS
Lawen
J
J
McAlister
V
V
Kiberd
B
B
D000328:Adult; D016572:Cyclosporine / Q000627:therapeutic use; D005190:Family; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006239:Haplotypes; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000032:analysis*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male
D006680:HLA Antigens; D007166:Immunosuppressive Agents; D007518:Isoantibodies; D016572:Cyclosporine