title: Pretransplant virtual PRA and long-term outcomes of kidney transplant recipients.
abstract: Virtual panel-reactive antibodies (vPRA) have been implemented to gauge sensitization worldwide. It is unclear how it associates with long-term outcomes, and its correlation with peak (pPRA) or actual (aPRA) has not been studied. We retrospectively reviewed data from 18- to 65-year-old kidney-only transplant patients during 1.1.1996-31.7.2011 in our center. PRAs were calculated based on solid-phase techniques. Of the 726 qualified cases, regardless of the PRA type, sensitized patients (PRA > 5%) had more females and previous transplant. Highly sensitized (HS, PRA > 50%) had longer waiting time, lower transplant rate, less living donor, more delayed graft function, and acute rejection. The conformity between vPRA and pPRA in HS was 75%, 57% between pPRA and aPRA. Forty-three percent (61/142) patients whose pPRA was >5% had no detectable aPRA and maintained similar outcomes as sensitized patients. Multivariate analysis showed consistently lower death-censored graft survival in HS defined by vPRA [HR 2.086 (95% CI 1.078-4.037), P < 0.05] and pPRA [HR 2.139 (95% CI 1.024-4.487), P < 0.05]. Both vPRA and pPRA provided reliable way estimating sensitization and predicting long-term graft survival, while aPRA might underestimate true sensitization. vPRA might be the most objective parameter to gauge sensitization.
authors: Section of Nephrology, Department of Medicine, Georgia Regents University Medical Centre, Augusta, GA, USA.
authors: Lu
authors: L
authors: Huber
authors: Center for Transfusion Medicine and Cell Therapy, Regional Tissue Typing Laboratory, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors: Nils
authors: N
authors: Lachmann
authors: Center for Transfusion Medicine and Cell Therapy, Regional Tissue Typing Laboratory, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors: Matthias
authors: M
authors: Niemann
authors: Department of Nephrology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors: Marcel
authors: M
authors: Naik
authors: Department of Nephrology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors: Lutz
authors: L
authors: Liefeldt
authors: Department of Nephrology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors: Petra
authors: P
authors: Glander
authors: Department of Nephrology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors: Danilo
authors: D
authors: Schmidt
authors: Department of Nephrology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors: Fabian
authors: F
authors: Halleck
authors: Department of Nephrology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors: Johannes
authors: J
authors: Waiser
authors: Department of Nephrology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors: Susanne
authors: S
authors: Brakemeier
authors: Department of Nephrology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors: Hans H
authors: HH
authors: Neumayer
authors: Center for Transfusion Medicine and Cell Therapy, Regional Tissue Typing Laboratory, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors: Constanze
authors: C
authors: Schönemann
authors: Department of Nephrology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors: Klemens
authors: K
authors: Budde
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000737:chemistry*; D001706:Biopsy; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007668:Kidney / Q000276:immunology; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D012189:Retrospective Studies; D014019:Tissue Donors; D066027:Transplant Recipients; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000906:Antibodies
keywords: graft survival; panel-reactive antibodies; sensitization; virtual PRA