title: Evaluation of pretransplant immunologic status in kidney-transplant recipients by panel reactive antibody and soluble CD30 determinations.
abstract: OBJECTIVE
  To retrospectively compare the accuracy of pretransplant panel of reactivity antibodies (PRA) and serum level of soluble CD30 (sCD30) in predicting early (<6 months) acute rejection (AR) in living-donor and deceased-donor kidney-transplant (KT) patients.
  
  
  METHODS
  Pretransplant sera of 24 KT recipients were retrospectively tested for sCD30 and compared with PRA. Inclusion criteria were de novo graft patients on calcineurin-inhibitor-based immunosuppression, minimum follow-up of 1 year, alive with a functioning graft, and stable renal function over the last 12 months. Objective measures were incidence of biopsy-proven AR (BPAR) within 6 months of KT and sCD30 and PRA diagnostic indexes. The relative risk (RR) of BPAR for each test was also obtained.
  
  
  RESULTS
  Fourteen (58.3%) patients presented at least one episode of BPAR within 6 months of KT. All rejection episodes were responsive to steroid treatment. PRA was positive in six (25%) patients, and four (66.7%) of them presented at least one episode of BPAR. sCD30 tested positive in nine (37.5%) patients, and all these later presented at least one episode of BPAR. sCD30 and PRA diagnostic indexes in predicting early (< 6months) BPAR were sensitivity 64.2% versus 28.5%; specificity 100% versus 80%; accuracy 79.1% versus 50%; positive predictive value 100% versus 66.6%; and negative predictive value 66.6% versus 44.4%. The RR of early AR was 1.4 in PRA-positive patients and extremely higher in the sCD30-positive group.
  
  
  CONCLUSIONS
  Pretransplant sCD30 is a more accurate predictor of AR when compared with PRA. These results support its use in the pretransplant work-up of kidney-graft recipients.
authors.affiliation: General and Transplant Surgery, La Sapienza University of Rome, Policlinico Umberto I, Rome, Italy. paola.cinti@uniroma1.it
authors.forename: Paola
authors.initials: P
authors.lastname: Cinti
authors.forename: Renzo
authors.initials: R
authors.lastname: Pretagostini
authors.forename: Alessia
authors.initials: A
authors.lastname: Arpino
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Tamburro
authors.forename: Sonia
authors.initials: S
authors.lastname: Mengasini
authors.forename: Roberto
authors.initials: R
authors.lastname: Lattanzi
authors.forename: Paolo
authors.initials: P
authors.lastname: De Simone
authors.forename: Pasquale
authors.initials: P
authors.lastname: Berloco
authors.forename: Elvira Renna
authors.initials: ER
authors.lastname: Molajoni
mesh_terms: D015703:Antigens, CD / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002102:Cadaver; D006084:Graft Rejection / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D015994:Incidence; D007518:Isoantibodies / Q000097:blood*; D017730:Ki-1 Antigen / Q000097:blood*; D016030:Kidney Transplantation / Q000276:immunology*; D019520:Living Donors; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014019:Tissue Donors
chemical_list: D015703:Antigens, CD; D015415:Biomarkers; D007518:Isoantibodies; D017730:Ki-1 Antigen