title: Peak panel reactive antibody, cancer, graft, and patient outcomes in kidney transplant recipients.
abstract: BACKGROUND
  High levels of pretransplant panel reactive antibodies (PRA) are known to be associated with detrimental effects on graft outcomes, but the association between pretransplant PRA levels and long-term patient outcomes is unclear.
  
  
  METHODS
  Using the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), we assessed the risk of rejection, graft failure, mortality and cancer in kidney transplant recipients with varying peak PRA levels.
  
  
  RESULTS
  In 7,118 kidney transplant recipients between 1997 and 2009, there were a total of 3,171 (44.6%), 3,306 (46.4%), 323 (4.5%), and 318 (4.5%) recipients with peak PRA levels of 0%, 1% to 50%, 51% to 80%, and greater than 80%, respectively. Compared to recipients with 0% peak PRA level, recipients with peak PRA levels greater than 80% were at increased risk of acute rejection (odds ratio, 1.81, 95% confidence interval [95% CI], 1.30-2.35; P < 0.001), death censored graft failure (hazard ratio [HR], 2.06; 95% CI, 1.46-2.91; P < 0.001), all-cause mortality (HR, 1.56; 95% CI, 1.15-2.11; P < 0.001) and cancer (HR, 1.94; 95% CI, 1.26-2.97; P = 0.002) in the adjusted models independent of human leukocyte antigen mismatches and initial immunosuppression.
  
  
  CONCLUSIONS
  Highly sensitized kidney transplant recipients with peak PRA greater than 80% had a greater risk of rejection, graft failure, cancer and death independent of age and time on dialysis. Strategies to reduce transplant waiting time and avoidance of sensitization in all potential transplant candidates are imperative to improve the overall graft and patient survival.
authors.affiliation: 1 Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. 2 Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia. 3 Sydney School of Public Health, University of Sydney, New South Wales, Australia. 4 Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia.
authors.forename: Wai H
authors.initials: WH
authors.lastname: Lim
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology
chemical_list: D007518:Isoantibodies