title: Impact of Pretransplant Panel-Reactive Antibody Level on Renal Graft Survival in Patients With a Negative Crossmatch and No Donor-Specific Antibody.
abstract: BACKGROUND
  Patients with high panel-reactive antibody (PRA) levels before transplantation tend to remain on the waiting list longer when considering cadaveric donor transplantation and have worse outcomes than those with lower PRA levels. This study investigated the impact of the pretransplantation PRA level on rejection and graft survival after kidney transplantation in patients with a negative crossmatch (CXM(-)) and no donor-specific antibody (DSA(-)).
  
  
  METHODS
  We retrospectively analyzed 513 recipients of kidney allograft treated from January 2009 to April 2013. Those who tested positive on crossmatching, had donor-specific antibodies, were ABO incompatible, or had no PRA level data were excluded (n = 130). The remaining patients were stratified into 3 groups according to their PRA levels: group I, PRA = 0 (314 [80.1%]); group II, PRA ≤50% (27 [7.2%]); and group III, PRA >50% (27 [7.2%]). Graft failure was defined as a return to dialysis, transplant nephrectomy, or death with a functioning kidney.
  
  
  RESULTS
  The mean patient follow-up was 30.4 ± 4.6 months. The rejection rate was 20.1% (group I, 18.5% [n = 58] vs group II, 23.8% [n = 10] vs group III, 33.3% [n = 9] [P = .053]). The graft failure rate was 21.7% (group I, 6.4% [n = 20] vs group II. 7.1% [n = 3] vs group III, 7.4% [n = 7] [P = .792]), and the 3-year graft survival rates were 96.3, 92.4, and 92.5%, respectively (P = .851).
  
  
  CONCLUSIONS
  The pretransplant PRA level was not significantly associated with graft survival in patients with CXM(-) and DSA(-). However, the rejection rate tended toward significance as the PRA level increased (P = .053).
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: K W
authors.initials: KW
authors.lastname: Jun
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: M H
authors.initials: MH
authors.lastname: Kim
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejoen, Korea.
authors.forename: J K
authors.initials: JK
authors.lastname: Hwang
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Korea.
authors.forename: S D
authors.initials: SD
authors.lastname: Kim
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Gyeonggi-do, Korea.
authors.forename: S C
authors.initials: SC
authors.lastname: Park
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, The Catholic University of Korea, St. Vincent Hospital, Gyeonggi-do, Korea.
authors.forename: Y S
authors.initials: YS
authors.lastname: Won
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: I S
authors.initials: IS
authors.lastname: Moon
authors.affiliation: Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: B H
authors.initials: BH
authors.lastname: Chung
authors.affiliation: Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: B S
authors.initials: BS
authors.lastname: Choi
authors.affiliation: Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: C W
authors.initials: CW
authors.lastname: Yang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: Y S
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Division of Vascular and Transplant Surgery, Department of Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea. Electronic address: cmckji@catholic.ac.kr.
authors.forename: J I
authors.initials: JI
authors.lastname: Kim
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors