Dec 30, 2014

Peak panel reactive antibody, cancer, graft, and patient outcomes in kidney transplant recipients

Transplantation
Wai H LimGermaine Wong

Abstract

High levels of pretransplant panel reactive antibodies (PRA) are known to be associated with detrimental effects on graft outcomes, but the association between pretransplant PRA levels and long-term patient outcomes is unclear. Using the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), we assessed the risk of rejection, graft failure, mortality and cancer in kidney transplant recipients with varying peak PRA levels. In 7,118 kidney transplant recipients between 1997 and 2009, there were a total of 3,171 (44.6%), 3,306 (46.4%), 323 (4.5%), and 318 (4.5%) recipients with peak PRA levels of 0%, 1% to 50%, 51% to 80%, and greater than 80%, respectively. Compared to recipients with 0% peak PRA level, recipients with peak PRA levels greater than 80% were at increased risk of acute rejection (odds ratio, 1.81, 95% confidence interval [95% CI], 1.30-2.35; P < 0.001), death censored graft failure (hazard ratio [HR], 2.06; 95% CI, 1.46-2.91; P < 0.001), all-cause mortality (HR, 1.56; 95% CI, 1.15-2.11; P < 0.001) and cancer (HR, 1.94; 95% CI, 1.26-2.97; P = 0.002) in the adjusted models independent of human leukocyte antigen mismatches and initial immunosuppression. Highly sensitized kidney transplant recipients wit...Continue Reading

Mentioned in this Paper

Decreased Immunologic Activity [PE]
Pancreatitis, Graft
Graft Survival
Isoantibodies
HLA Antigens
Graft Rejection
Adjustment Disorders
Malignant Neoplasms
Histocompatibility Antigens Class I
Kidney Transplantation

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