The importance of PRA detection and PRA clearance in cadaveric renal transplantation

Objective: To evaluate the short- and long-term effects of panel reactive antibody (PRA) examination and PRA clearance on the patient/kidney survival after cadaveric renal transplantation. Method: We reviewed the records of 1 277 patients who underwent cadaveric renal transplantation with good human leukocyte antigen (HLA) matching with the donors from 1978 to 1998. Four hundred and twenty-three patients underwent renal transplantation from 1978 to 1990 without PRA examination made up the first group. The other 854 patients with PRA level examination before the operation from 1991 to 1998 were regarded as the second group. Preoperative plasmaphereses were performed for those with PM levels higher than 30%. The episodes of hyperacute rejection, acute rejection and l-, 3- and 5-year patient/graft survival rate were evaluated. To rule out the interference of different immunosuppressants, we made a comparative study between the recipients with uncorrectable high PRA levels ( 20% ) in the second group and those with reduced PRA levels ( 10% ) by plasmaphere- sis. Results: In the first group, 9 (2.l%) hyperacute rejection and 198 (47%) acute rejection occurred The 1-, 3- and 5-year patient/graft survival rates were 86. 7%/76. 3%, 72. 5%/67. 9% and 87 .0%/81. 6%, respectively. In the second group, no hyperacute rejection happened and acute rejection was occurred in 162 cases (19.0% ), and the l-, 3- and 5year patient/graft survival rates were 97. 3%/95.0%, 92%/84. 2% and 87.0%/81 .6%, much lower than that in the first group. Of the 49 recipients with high PRA levels, 33 had PRA levels below 10% after plasmapheresis, who had a lower incidence of ocute rejection, a higher rate of rejection reversal and a higher graft survival rate at 1, 3 and 5 years than the rest 16 cases (PRA 20% after plasmapheresis). Conclusion: The PRA level examination and PRA clearance are important for the success of renal transplantation. They help eradicate the hyperacute rejection, reduce the risk of acute rejection and improve patient and graft survival.