J Korean Soc Transplant.
2002 Jun;16(1):47-56.
Clinical Implications of Pre-Transplantation Panel Reactive Antibody in Renal Transplantation in Koreans
- Affiliations
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- 1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. sjkimgs@plaza.snu.ac.kr
- 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
- 3Department of Clinical Pathology, Seoul National University College of Medicine, Seoul, Korea.
- 4Department of Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Abstract
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PURPOSE: Panel reactive antibody (PRA) is a screening test for HLA alloimmunization. The purpose of this study is to clarify the clinical implications of pre-transplantation PRA in renal transplantation in Koreans.
METHODS
Study subjects included 99 renal transplant recipients whose HLA cross match tests were conducted between Jan. 1994 and Dec. 1995. Their sera were tested for PRA using 50 lymphocyte panels from Koreans by NIH and AHG methods.
RESULTS
PRA was positive in 18 (18%) patients by NIH method, and in 19 (19%) patients by AHG method. NIH PRA positivity was higher in the female group (33% vs. 12% in males, P=0.01) while the age of AHG PRA (+) group was higher than the (-) group (37+/-16 vs. 28+/-13, P<0.05). Overall 5-yr graft survival rate was 92%. Donor age was higher (42+/-11 vs. 27+/-16, P<0.0001) and HLA was better matched (Chi-square, P<0.01) in the living compared to the cadaveric group. In univariate analysis, recipient age > 45, donor age > 50 and AHG PRA (+) were associated with worse graft survival. In multivariate analysis, donor age > 50 along with AHG PRA (+), or donor age > 50 with recipient age > 45 were significant prognostic factors for graft survival. Recipient age >45, donor age > 50 and AHG PRA (+) were still prognostic of long-term graft fates in cadaveric transplants.
CONCLUSION
AHG PRA correlates better with clinical data than NIH PRA and pre-transplant PRA is a significant prognostic factor for long-term graft fates in cadaveric renal recipients in Koreans.
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