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Effect of Recipient Sensitization (Peak PRA) on Graft Outcome in Haploidentical Living Related Kidney Transplants
Clinical Transplantation (2000)
  • A. Barama
  • U. Oza
  • R. Panek
  • P. Belitsky
  • A. S. MacDonald
  • J. Lawen
  • Vivian McAlister
  • B. Kiberd

OBJECTIVE: To evaluate the influence of pre-transplant recipient sensitization on the outcome of 1-haploidentical live related donor (LRD) kidney transplants.

METHOD: We reviewed 141 consecutive cyclosporine-treated adult haploidentical first transplants for which panel reactive antibody (PRA) levels were available. Patients were divided into three groups according to their peak PRA levels: group I, PRA = 0 (n = 97); group II, PRA = 1-50% (n = 24); and group III, PRA = 51-100% (n = 20).

RESULTS: Differences in PRA were associated with significant differences in short- and longer-term graft survival, unrelated to patient survival. Graft survival at 1, 3, and 5 yr was only 74, 40, and 27% in group III, compared to 92, 87, and 52% in group II, and 96, 91, and 85% in group I (p < 0.001). Increasing PRA was associated with shorter time-to-graft failure. In group III, 20% lost their transplant from acute rejection in the first 6 months, versus 4% in group II and 3% in group I (p < 0.01). Graft survival in group II diverged from that of group I only after 3 yr, due to an increase in loss from chronic rejection. Hospitalization was longer in group III, in association with a significantly higher incidence of acute rejection during the first 3 months after transplantation (p < 0.02). Serum creatinine was higher in sensitized than nonsensitized patients at all time points.

CONCLUSIONS: Sensitization has a significant negative impact on the outcome of haploidentical LRD kidney transplants. Sensitized potential recipients and their potential donors should be aware of this in arriving at informed decision-making for transplantation. These patients may benefit from more sensitive cross-match testing, more intense or more novel immunosuppression, or immunomodulation to modify their immune responsiveness.

  • Cyclosporine,
  • Graft Survival,
  • HLA Antigens,
  • Haplotypes,
  • Histocompatibility Testing,
  • Immunosuppressive Agents,
  • Isoantibodies,
  • Kidney Transplantation,
  • Living Donors
Publication Date
June, 2000
Publisher Statement
Dr. Vivian McAlister is currently a faculty member at The University of Western Ontario.
Citation Information
A. Barama, U. Oza, R. Panek, P. Belitsky, et al.. "Effect of Recipient Sensitization (Peak PRA) on Graft Outcome in Haploidentical Living Related Kidney Transplants" Clinical Transplantation Vol. 14 Iss. 3 (2000)
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