The detection of specific anti-HLA antibodies in recipients of renal transplant and its clinical application

Objective To investigate the effect of HLA-specific antibodies, population reactive antibody (PRA), on the outcome of renal allografts. Methods Serum PRA in the recipients with 897 case/times of renal transplantation was determined by using enzyme-linked immunosorbent assay (ELISA) with lambda antigen tray (LAT) and complement dependent lymphocytotoxicity (CDC) techniques with lambda cell tray (LCT) to compare their specificity and sensitivity. Results There were 121 recipients with positive PRA in 856 recipients of primary renal transplantation with the positive rate being 11%. PRA positive rate of the recipients in the 33 cases of second renal transplant and 8 cases of third renal transplant was 58% and 87% respectively (both P＜0.001). Rejection rate of renal post-transplantation in the positive PRA recipients was 40% and only 17% in the negative PRA recipients (P＜0.001). Graft survival rate was decreased significantly in the positive PRA group, especially in the highly sensitized recipients with PRA＞40% the graft survival rate at 1-, 3-, 5-, and 7-years were decreased by 24%, 38%, 57% and 56% respectively as comparing with that in the negative PRA group (all P＜0.001). False-positive rate and false-negative rate of CDC-PRA in 319 serum samples were 3.8% and 3.1% respectively by blindly determination of PRA using ELISA compared with CDC techniques. Conclusion PRA determination was a sensitive indictor predicting the sensitivity status of the recipients and there were significant influence on graft survival and rejections.