Panel-reactive antibodies in kidney transplantation for patients with end-stage renal failure

Abstract

BACKGROUND: Kidney transplantation is a recognized method of treating patients with end–stage kidney disease. However, the risk of graft loss is not excluded. In Azerbaijan, kidney transplantation is mainly performed from living donors; nevertheless, there is little data on the panel-reactive antibodies (PRA) and its use in the transplantation program.

AIM: To evaluate the prevalence of positive panel-reactive antibodies (PRA) and short-term outcomes of living donor kidney transplantation.

MATERIALS AND METHODS: Within 6 months after kidney transplantation, 113 recipients were followed up. All patients underwent their first transplantation. Complement-dependent cytotoxicity cross-matching, HLA typing, and flow cytometry cross-matching were carried out. Flow cytometric analysis was applied to detect PRA. The positive response percentage is presented by the percentage of events shifted to the right of the cutoff point. Data were analyzed using SPSS 16.0 statistical software.

RESULTS: Among the examined patients, men predominated. In PRA-positive patients (n = 20), the dialysis duration was on average 22.3% longer than in PRA-negative patients (n = 93). 35.0% of PRA-positive patients had class I PRA, 30.0% of patients had class II PRA, and 35.0% had class I + II PRA. In 40.0% of cases, positive PRA had high sensitization >50% (predominantly class II), and the remaining 60.0% had PRA from 10% to 50%. Sensitizing factors were more common in the PRA-positive group (p < 0.05). After 6 months of folow-up, the mean creatinine level was 183.4 ± 68.84 nmol/l in the PRA-positive group and 198.15 ± 108.23 nmol/l in the PRA-negative group (p = 0.91). The overall emptying rate was 4.4% (n = 5), with all 5 cases being in the PRA-negative group. No deaths were observed during the follow-up period.

CONCLUSIONS: PRA positive patients usually have some sensitizing event such as pregnancy or blood transfusion. The transfusion itself was not a significant factor of sensitization in this study. Patients with high PRA levels require more thorough examination.

Keywords

panel-reactive antibody / renal failure / kidney transplantation / sensitizing factors

References

[1] Daineko VS, Ananiev AN, Nevirovich ES, et al. The structure and incidence of infection in the cysts in patients with autosom al dominant polycystic kidney disease on the waiting list of kidney transplantation. Russian Journal of Transplantology and Artificial Organs. 2018;20(3): 20–25. EDN: XWXTJJ doi: 10.15825/1995-1191-2018-3-20-25

[2] Дайнеко В.С., Ананьев А.Н., Невирович Е.С., и др. Структура и частота встречаемости инфекции в кистах у пациентов с аутосомно-доминантным поликистозом почек в листе ожидания трансплантации почки // Вестник трансплантологии и искусственных органов. 2018. Т 20, № 3. С. 20–25. EDN: XWXTJJ doi: 10.15825/1995-1191-2018-3-20-25

[3] Daineko VS, Ananiev AN, Nevirovich ES, et al. The structure and incidence of infection in the cysts in patients with autosom al dominant polycystic kidney disease on the waiting list of kidney transplantation. Russian Journal of Transplantology and Artificial Organs. 2018;20(3): 20–25. EDN: XWXTJJ doi: 10.15825/1995-1191-2018-3-20-25

[4] Daineko VS, Ananiev AN, Nevirovich ES, et al. Results of kidney transplantation in patients with end-stage renal failure caused by autosomal dominant polycystic kidney disease. Russian Journal of Transplantology and Artificial Organs. 2019;21(2):39–48. EDN: KGDZWP doi: 10.15825/1995-1191-2019-2-39-48

[5] Дайнеко В.С., Ананьев А.Н., Невирович Е.С., и др. Результаты трансплантации почки пациентам с терминальной почечной недостаточностью, обусловленной аутосомно-доминантным поликистозом почек // Вестник трансплантологии и искусственных органов. 2019. Т. 21, № 2. С. 39–48. EDN: KGDZWP doi: 10.15825/1995-1191-2019-2-39-48

[6] Daineko VS, Ananiev AN, Nevirovich ES, et al. Results of kidney transplantation in patients with end-stage renal failure caused by autosomal dominant polycystic kidney disease. Russian Journal of Transplantology and Artificial Organs. 2019;21(2):39–48. EDN: KGDZWP doi: 10.15825/1995-1191-2019-2-39-48

[7] Zhang R. Donor-specific antibodies in kidney transplant recipients. Clin J Am Soc Nephrol. 2018;13(1):182–192. doi: 10.2215/CJN.00700117

[8] Zhang R. Donor-specific antibodies in kidney transplant recipients // Clin J Am Soc Nephrol. 2018. Vol. 13, N 1. P. 182–192. doi: 10.2215/CJN.00700117

[9] Zhang R. Donor-specific antibodies in kidney transplant recipients. Clin J Am Soc Nephrol. 2018;13(1):182–192. doi: 10.2215/CJN.00700117

[10] Khrabrova MS, Dobronravov VA, Nabokow AV, et al. Prognosis of kidney allograft survival: immunological risk and rejection type. Nephrology (Saint Petersburg). 2015;19(4):41–50. EDN: UCGDDZ

[11] Храброва М.С., Добронравов В.А., Набоков А.В., и др. Прогноз выживаемости почечного трансплантата: иммунологический риск и тип отторжения // Нефрология. 2015. Т. 19, № 4. С. 41–50. EDN: UCGDDZ

[12] Khrabrova MS, Dobronravov VA, Nabokow AV, et al. Prognosis of kidney allograft survival: immunological risk and rejection type. Nephrology (Saint Petersburg). 2015;19(4):41–50. EDN: UCGDDZ

[13] Thaunat O, Koenig A, Leibler C, Grimbert P. Effect of immunosuppressive drugs on humoral allosensitization after kidney transplant. J Am Soc Nephrol. 2016;27(7):1890–1900. doi: 10.1681/ASN.2015070781

[14] Thaunat O., Koenig A., Leibler C., Grimbert P. Effect of immunosuppressive drugs on humoral allosensitization after kidney transplant // J Am Soc Nephrol. 2016. Vol. 27, N 7. P. 1890–1900. doi: 10.1681/ASN.2015070781

[15] Thaunat O, Koenig A, Leibler C, Grimbert P. Effect of immunosuppressive drugs on humoral allosensitization after kidney transplant. J Am Soc Nephrol. 2016;27(7):1890–1900. doi: 10.1681/ASN.2015070781

[16] Lan JH, Kadatz M, Chang DT, et al. Pretransplant calculated panel reactive antibody in the absence of donor-specific antibody and kidney allograft survival. Clin J Am Soc Nephrol. 2021;16(2):275–283. doi: 10.2215/CJN.13640820

[17] Lan J.H., Kadatz M., Chang D.T., et al. Pretransplant calculated panel reactive antibody in the absence of donor-specific antibody and kidney allograft survival // Clin J Am Soc Nephrol. 2021. Vol. 16, N 2. P. 275–283. doi: 10.2215/CJN.13640820

[18] Lan JH, Kadatz M, Chang DT, et al. Pretransplant calculated panel reactive antibody in the absence of donor-specific antibody and kidney allograft survival. Clin J Am Soc Nephrol. 2021;16(2):275–283. doi: 10.2215/CJN.13640820

[19] Filippone EJ, Farber JL. Humoral immune response and allograft function in kidney transplantation. Am J Kidney Dis. 2015;66(2): 337–347. doi: 10.1053/j.ajkd.2015.03.033

[20] Filippone E.J., Farber J.L. Humoral immune response and allograft function in kidney transplantation // Am J Kidney Dis. 2015. Vol. 66, N 2. P. 337–347. doi: 10.1053/j.ajkd.2015.03.033

[21] Filippone EJ, Farber JL. Humoral immune response and allograft function in kidney transplantation. Am J Kidney Dis. 2015;66(2): 337–347. doi: 10.1053/j.ajkd.2015.03.033

[22] Valenzuela NM, Reed EF. Antibodies in transplantation: The effects of HLA and non-HLA antibody binding and mechanisms of injury. In: Zachary A, Leffell M, editors. Transplantation immunology. Methods in molecular biology. Vol. 1034. New Jersey: Humana Press, 2013. P. 41–70. doi: 10.1007/978-1-62703-493-7_2

[23] Valenzuela N.M., Reed E.F. Antibodies in transplantation: The effects of HLA and non-HLA antibody binding and mechanisms of injury. В кн.: Transplantation immunology. Methods in molecular biology. Vol. 1034 / A. Zachary, M. Leffell, editors. New Jersey: Humana Press, 2013. P. 41–70. doi: 10.1007/978-1-62703-493-7_2

[24] Valenzuela NM, Reed EF. Antibodies in transplantation: The effects of HLA and non-HLA antibody binding and mechanisms of injury. In: Zachary A, Leffell M, editors. Transplantation immunology. Methods in molecular biology. Vol. 1034. New Jersey: Humana Press, 2013. P. 41–70. doi: 10.1007/978-1-62703-493-7_2

[25] Loupy A, Vernerey D, Tinel C, et al. Subclinical rejection phenotypes at 1 year post-transplant and outcome of kidney allografts. J Am Soc Nephrol. 2015;26(7):1721–1731. doi: 10.1681/ASN.2014040399

[26] Loupy A., Vernerey D., Tinel C., et al. Subclinical rejection phenotypes at 1 year post-transplant and outcome of kidney allografts // J Am Soc Nephrol. 2015. Vol. 26, N 7. P. 1721–1731. doi: 10.1681/ASN.2014040399

[27] Loupy A, Vernerey D, Tinel C, et al. Subclinical rejection phenotypes at 1 year post-transplant and outcome of kidney allografts. J Am Soc Nephrol. 2015;26(7):1721–1731. doi: 10.1681/ASN.2014040399

[28] Jun KW, Kim MH, Hwang JK, et al. Impact of pretransplant panel-reactive antibody level on renal graft survival in patients with a negative crossmatch and no donor-specific antibody. Transplant Proc. 2016;48(3):770–772. doi: 10.1016/j.transproceed.2015.12.099

[29] Jun K.W., Kim M.H., Hwang J.K., et al. Impact of pretransplant panel-reactive antibody level on renal graft survival in patients with a negative crossmatch and no donor-specific antibody // Transplant Proc. 2016. Vol. 48, N 3. P. 770–772. doi: 10.1016/j.transproceed.2015.12.099

[30] Jun KW, Kim MH, Hwang JK, et al. Impact of pretransplant panel-reactive antibody level on renal graft survival in patients with a negative crossmatch and no donor-specific antibody. Transplant Proc. 2016;48(3):770–772. doi: 10.1016/j.transproceed.2015.12.099

[31] Gadde AB, Mahapatra A, Tiwari A, et al. Use of panel reactive antibodies for immunological risk stratification and its correlation with antecedent events in live donor kidney transplant: A prospective single-center study. Indian J Transplant. 2021;15(1):39–44. doi: 10.4103/ijot.ijot_55_20

[32] Gadde A.B., Mahapatra A., Tiwari A., et al. Use of panel reactive antibodies for immunological risk stratification and its correlation with antecedent events in live donor kidney transplant: A prospective single-center study // Indian J Transplant. 2021. Vol. 15, N 1. P. 39–44. doi: 10.4103/ijot.ijot_55_20

[33] Gadde AB, Mahapatra A, Tiwari A, et al. Use of panel reactive antibodies for immunological risk stratification and its correlation with antecedent events in live donor kidney transplant: A prospective single-center study. Indian J Transplant. 2021;15(1):39–44. doi: 10.4103/ijot.ijot_55_20

[34] Matas AJ, Smith JM, Skeans MA, et al. OPTN/SRTR2013 Annual data report: Kidney. Am J Transplant. 2015;15(S2):1–34. doi: 10.1111/ajt.13195

[35] Matas A.J., Smith J.M., Skeans M.A., et al. OPTN/SRTR2013 Annual data report: Kidney // Am J Transplant. 2015. Vol. 15, N S2. P. 1–34. doi: 10.1111/ajt.13195

[36] Matas AJ, Smith JM, Skeans MA, et al. OPTN/SRTR2013 Annual data report: Kidney. Am J Transplant. 2015;15(S2):1–34. doi: 10.1111/ajt.13195

[37] Shang W, Dong L, Feng G, et al. Panel-reactive antibody levels and renal transplantation rates in sensitized patients after desensitization and human leucocyte antigen amino acid residue matching. J Int Med Res. 2013;41:1333–1341. doi: 10.1177/0300060513485896

[38] Shang W., Dong L., Feng G., et al. Panel-reactive antibody levels and renal transplantation rates in sensitized patients after desensitization and human leucocyte antigen amino acid residue matching // J Int Med Res. 2013. Vol. 41. P. 1333–1341. doi: 10.1177/0300060513485896

[39] Shang W, Dong L, Feng G, et al. Panel-reactive antibody levels and renal transplantation rates in sensitized patients after desensitization and human leucocyte antigen amino acid residue matching. J Int Med Res. 2013;41:1333–1341. doi: 10.1177/0300060513485896

[40] Malheiro J, Tafulo S, Dias L, et al. Analysis of preformed donor-specific anti-HLA antibodies characteristics for prediction of antibody-mediated rejection in kidney transplantation. Transpl Immunol. 2015;32(2):66–71. doi: 10.1016/j.trim.2015.01.002

[41] Malheiro J., Tafulo S., Dias L., et al. Analysis of preformed donor-specific anti-HLA antibodies characteristics for prediction of antibody-mediated rejection in kidney transplantation // Transpl Immunol. 2015. Vol. 32, N 2. P. 66–71. doi: 10.1016/j.trim.2015.01.002

[42] Malheiro J, Tafulo S, Dias L, et al. Analysis of preformed donor-specific anti-HLA antibodies characteristics for prediction of antibody-mediated rejection in kidney transplantation. Transpl Immunol. 2015;32(2):66–71. doi: 10.1016/j.trim.2015.01.002

[43] Hyun J, Park KD, Yoo Y, et al. Effects of different sensitization events on HLA alloimmunization in solid organ transplantation patients. Transplant Proc. 2012;44(1):222–225. doi: 10.1016/j.transproceed.2011.12.049

[44] Hyun J., Park K.D., Yoo Y., et al. Effects of different sensitization events on HLA alloimmunization in solid organ transplantation patients // Transplant Proc. 2012. Vol. 44, N 1. P. 222–225. doi: 10.1016/j.transproceed.2011.12.049

[45] Hyun J, Park KD, Yoo Y, et al. Effects of different sensitization events on HLA alloimmunization in solid organ transplantation patients. Transplant Proc. 2012;44(1):222–225. doi: 10.1016/j.transproceed.2011.12.049

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