Significance of HLA Antibody Detected by PRA-Bead Method in Kidney Transplant Outcomes

The impact of specific HLA antibodies on the allograft function in the Luminex era is not clearly known. This study aimed to investigate kidney transplantation outcomes in patients with different anti-HLA antibody status as detected by Luminex PRA.

This retrospective study included 106 deceased-donor kidney transplantation (DDKT) patients divided into 3 groups by PRA status as detected by PRA-bead: (1) PRA = 0; (2) positive PRA but with negative antibody against donor's HLA antigens; and (3) positive PRA with positive anti-HLA antibody specificity against donor's HLA antigens.

There were 65, 23, and 18 patients in groups 1, 2, and 3, respectively. Early allograft rejections were highest in group 3 (22.2%) (P = .02). In multivariate analysis, delayed graft function was the only factor that was associated with allograft rejection (hazard ratio, 8.9; 95% confidence interval, 1.9-39.8; P = .004). Estimated glomerular filtration rates at 1 year of the 3 groups were 54.6, 55.8, and 60.0 mL/min (P = .71). One-year allograft failure and death were not different among the 3 groups. Expanded-criteria deceased donors were associated with both allograft failure (P = .003) and patient death (P = .02).

Anti-HLA antibody as detected by Luminex PRA was associated with early allograft rejection but not graft or patient survival. The effect of newer treatment modalities can improve the outcomes of PRA-positive patients to be similar to nonsensitized patients at 1 year.