title: Risk factors of sensitization to human leukocyte antigen in end-stage renal disease patients.
abstract: BACKGROUND
  Pre-sensitization to human leukocyte antigen (HLA) is closely related to the prognosis of renal transplantation. Concerning the risk factors for HLA sensitization, most studies focused only on selected transplant candidates.
  
  
  METHODS
  All patients with end-stage renal disease (ESRD) in a single teaching hospital and a group of healthy subjects were enrolled for the tests of panel-reactive antibodies (PRA).
  
  
  RESULTS
  A total of 1177 subjects were recruited, including 289 ESRD patients (140 hemodialysis, 98 peritoneal dialysis, and 51 pre-dialysis) and 888 healthy volunteers. The prevalence of PRA positivity (for either type I or II HLA) for ESRD patients was higher than for healthy subjects (23.2% vs. 12.8%, p=0.000). Only pregnancy and transfusion showed independent correlations with PRA positivity, and not ESRD itself. The PRA-positive ESRD patients were prone to be female, have histories of pregnancy, transfusion, no hepatitis B, and use of graft shunt for dialysis. Multivariate analyses showed that pregnancy and time interval of the latest transfusion had independent correlations with PRA positivity. The time interval of less than 1 year had the highest odds ratio 10.06 (p=0.000).
  
  
  CONCLUSIONS
  Pregnancy and recent transfusion, not ESRD itself or dialysis modality, remain the independent risk factors for HLA sensitization.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, E-DA Hospital, Kaohsiung City, Taiwan, ROC; School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan, ROC. Electronic address: ed100367@edah.org.tw.
authors.forename: Shih-Yuan
authors.initials: SY
authors.lastname: Hung
authors.affiliation: Department of Laboratory Medicine, E-DA Hospital/I-Shou University, Kaohsiung City, Taiwan, ROC; Department of Medical Research, E-DA Hospital/I-Shou University, Kaohsiung City, Taiwan, ROC.
authors.forename: Tsun-Mei
authors.initials: TM
authors.lastname: Lin
authors.affiliation: Division of Nephrology, Department of Internal Medicine, E-DA Hospital, Kaohsiung City, Taiwan, ROC.
authors.forename: Min-Yu
authors.initials: MY
authors.lastname: Chang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, E-DA Hospital, Kaohsiung City, Taiwan, ROC.
authors.forename: Hsi-Hao
authors.initials: HH
authors.lastname: Wang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, E-DA Hospital, Kaohsiung City, Taiwan, ROC.
authors.forename: Yi-Che
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, E-DA Hospital, Kaohsiung City, Taiwan, ROC.
authors.forename: Li-Chun
authors.initials: LC
authors.lastname: Ho
authors.affiliation: Division of Nephrology, Department of Internal Medicine, E-DA Hospital, Kaohsiung City, Taiwan, ROC.
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Chen
authors.affiliation: Kaohsiung Blood Center, Taiwan Blood Services Foundation, Kaohsiung City, Taiwan, ROC.
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Hung
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Hsin-Jen Hospital, New Taipei City, Taiwan, ROC.
authors.forename: Hung-Hsiang
authors.initials: HH
authors.lastname: Liou
mesh_terms: D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D015870:Gene Expression; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D006085:Graft Survival; D006680:HLA Antigens / Q000097:blood / Q000235:genetics / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000473:pathology / Q000601:surgery / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D006435:Renal Dialysis / Q000379:methods; D012307:Risk Factors; D014019:Tissue Donors; D065227:Transfusion Reaction; D014184:Transplantation, Homologous
chemical_list: D001323:Autoantibodies; D006680:HLA Antigens
keywords: Dialysis; End-stage renal disease; Human leukocyte antigen; Kidney transplantation; Panel-reactive antibody