The detection of panel reactive antibody in kidney transplantation

Objective The topic of human leukocyte antigen(HLA)-specific antibodies in transplantation has experienced a renaissance in the last decade with a renewed appreciation of their clinical relevance and an increased interest in their detection,identification,and treatment.This study was to investigate the role of panel reactive antibody(PRA) in kidney transplantation and clinical measures for recipients with high level PRA.Methods Serum PRA in 1527 cases of renal transplant recipients was determined by enzyme-linked immunosorbent assay(ELISA) with Lambda antigen tray(LAT).According to the PRA level,the recipients were divided into negative group(PRA10%),positive group(PRA≥10%),and 2 subgroups with 10%≤PRA50%(lowly sensitized) and PRA≥50%(highly sensitized).Plasma exchange therapy was used in 37 highly sensitized patients before transplantation.Results A total of 350 cases were detected positive PRA with a positive rate of 22.9%.Among them,94(26.8%) were highly sensitized.The rejection rate in the recipients with pretransplant positive PRA was 21.1% and only 3.8% in the negative PRA recipients(P0.01).The incidence of rejection of recipients with positive PRA after transplantation was higher than those with negative PRA(P0.01).No difference in the incidence of rejection was found between the recipients with plasma exchange or not.Patients who had history of transplantation,pregnancies,or transfusion were more susceptible.The rejection rate of patients with 3 HLA-A,B,or DR antigen mismatched was markedly higher than those with ≤3 mismatched(16.9% vs 1.7%,P0.01).Conclusion The detection of PRA before and after renal transplantation plays a very important role in predicting the occurrence of rejection.