title: Outcomes of renal transplantation in recipients with peak panel reactive antibody >30% under tacrolimus-based immunosuppression.
abstract: BACKGROUND
  Renal transplant recipients with high panel reactive antibodies (PRA) have worse outcomes than those with lower PRA. High PRA re-transplant recipients are thought to have worse outcomes than high PRA first transplant recipients. In this study, we examined outcomes of renal transplantation recipients with a peak PRA >30% and compared the outcomes of first and re-transplanted recipients.
  
  
  METHODS
  Survival outcomes between recipients of first transplants (n=68) and re-transplants (n=155) operated between June 1990 and August 2000 were compared. Sub-group analysis was done based on patient's gender, race and first/re-transplant. All patients received tacrolimus-based immunosuppression.
  
  
  RESULTS
  No difference in graft survival was noted between first and re-transplanted patients. Ten-year patient survival was better in the re-transplanted group (p<0.004). Factors affecting patient survival on univariate analysis were age >55 years (p=0.015), deceased donor transplant (p=0.009), first transplant patient (p=0.004) and diabetes mellitus (DM) as the cause of End Stage Renal Disease (ESRD) (p=0.005). On multivariable analysis, factors affecting patient survival were number of the transplant (re-transplant versus first transplant, Relative risk [RR]=0.54, p=0.009) and cause of ESRD (DM versus no DM, RR=1.91, p=0.012).Diabetes as a cause for ESRD was the only factor affecting graft survival on univariate(p=0.015) and multivariable analysis (DM versus no DM, RR=1.63, p=0.017).
  
  
  CONCLUSIONS
  High PRA recipients of first transplants had poorer patient survival than high PRA re-transplants. On multivariable analysis, diabetes etiology of ESRD and first transplantation were found to be independent risk factors for poorer patient survival.
authors.affiliation: Department of Surgery, Division of Transplantation, University of Pittsburgh, Thomas E. Starzl Transplantation Institute, PA, USA. basua@upmc.edu
authors.forename: Amit
authors.initials: A
authors.lastname: Basu
authors.forename: John
authors.initials: J
authors.lastname: Falcone
authors.forename: Igor
authors.initials: I
authors.lastname: Dvorchik
authors.forename: Henkie
authors.initials: H
authors.lastname: Tan
authors.forename: Kristine
authors.initials: K
authors.lastname: Schonder
authors.forename: J Wallis
authors.initials: JW
authors.lastname: Marsh
authors.forename: Adriana
authors.initials: A
authors.lastname: Zeevi
authors.forename: Abhinav
authors.initials: A
authors.lastname: Humar
authors.forename: Ron
authors.initials: R
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D000368:Aged; D003928:Diabetic Nephropathies / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012086:Reoperation; D012307:Risk Factors; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D007518:Isoantibodies; D016559:Tacrolimus