Effect of recipient sensitization (peak panel reactive antibodies) on 15-year survival after kidney transplantation.
BACKGROUND
Despite dynamic development within the field of transplantology, the immunization of a potential organ recipient remains an important issue for transplant teams. Panel reactive antibodies (PRA) identification in the serum of the recipient remains routine practice in the majority of transplantation centers. The influence of peak PRA levels on graft function is a well known fact. The aim of this study was to determine the effect of peak PRA on long-term survival after renal transplantation.


METHODS
The study was conducted on a group of 232 kidney recipients from multiorgan donors, transplanted in 6 transplant centers in Poland from 1995 to 1997. Data analyzed in this study included recipients' age, sex, PRA, HLA, number and time of hemodialyses after the transplantation, cold ischemia time, and etiology of end-stage renal disease. The effect of data examined in this study on mortality was evaluated at set time points at 5, 10, and 15 years after transplantation. The statistical methods included monofactorial and multifactorial Kaplan-Meier survival analysis and Cox proportional hazards model for mortality prediction. A P value of <.05 was considered to be statistically significant.


RESULTS
Among all of the analyzed factors, only peak PRA concentrations significantly correlated with increased mortality among renal transplant recipients. The results were analyzed in all of the set time points: P = .007 at 5 years, P = .014 at 10 years, and P = .05 at 15 years after transplantation.


CONCLUSIONS
The increased level of PRA in kidney recipients is a risk factor increasing mortality after the transplantation.
Department of Laboratory Diagnostic and Molecular Medicine, Pomeranian Medical University, Szczecin, Poland.
M
M
Kaczmarczyk
Department of Anesthesiology, Intensive Care, and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland.
K
K
Kotfis
Department of Anesthesiology, Intensive Care, and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland.
J
J
Biernawska
Department of Anesthesiology, Intensive Care, and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland.
L
L
Szydłowski
Clinical Microbiology, Teaching Hospital No 2, Pomeranian Medical University, Szczecin, Poland.
A
A
Zukowska
Department of Anesthesiology, Intensive Care, and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland.
K
K
Szliżewska
Department of Anesthesiology, Intensive Care, and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland.
M
M
Zegan-Barańska
Clinic of Anesthesiology and Intensive Care, Pomeranian Medical University, Szczecin, Poland.
R
R
Bohatyrewicz
Department of Anesthesiology, Intensive Care, and Acute Poisoning, Pomeranian Medical University, Szczecin, Poland. Electronic address: zukowski@sci.pam.szczecin.pl.
M
M
Zukowski
D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
D015415:Biomarkers; D006680:HLA Antigens; D007518:Isoantibodies