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Original ArticlesTransplantation
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Pretransplant Calculated Panel Reactive Antibody in the Absence of Donor-Specific Antibody and Kidney Allograft Survival

James H. Lan, Matthew Kadatz, Doris T. Chang, Jagbir Gill, Howard M. Gebel and John S. Gill
CJASN February 2021, 16 (2) 275-283; DOI: https://doi.org/10.2215/CJN.13640820
James H. Lan
1Vancouver Coastal Health Research Institute, Vancouver, Canada
2Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
3Division of Nephrology, Kidney Transplant Program, University of British Columbia, Vancouver, Canada
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Matthew Kadatz
1Vancouver Coastal Health Research Institute, Vancouver, Canada
3Division of Nephrology, Kidney Transplant Program, University of British Columbia, Vancouver, Canada
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Doris T. Chang
4Providence Health Research Institute, Vancouver, Canada
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Jagbir Gill
3Division of Nephrology, Kidney Transplant Program, University of British Columbia, Vancouver, Canada
4Providence Health Research Institute, Vancouver, Canada
5Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada
6School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Howard M. Gebel
7Department of Pathology, Emory University, Atlanta, Georgia
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John S. Gill
3Division of Nephrology, Kidney Transplant Program, University of British Columbia, Vancouver, Canada
4Providence Health Research Institute, Vancouver, Canada
8Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts
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Abstract

Background and objectives Panel reactive antibody informs the likelihood of finding an HLA-compatible donor for transplant candidates, but has historically been associated with acute rejection and allograft survival because testing methods could not exclude the presence of concomitant donor-specific antibodies. Despite new methods to exclude donor-specific antibodies, panel reactive antibody continues to be used to determine the choice of induction and maintenance immunosuppression. The study objective was to determine the clinical relevance of panel reactive antibody in the absence of donor-specific antibodies.

Design, setting, participants, & measurements Retrospective observational study of kidney allograft survival among 4058 zero HLA-A–, B-, DR-, and DQB1-mismatched transplant recipients without antibodies to donor kidney antigens encoded by these HLA gene loci.

Results Among 4058 first and repeat transplant recipients, patients with calculated panel reactive antibody (cPRA) 1%–97% were not at higher risk of transplant failure, compared with patients with cPRA of 0% (death censored graft loss: hazard ratio, 1.07; 95% confidence interval, 0.82 to 1.41). Patients with cPRA ≥98% had a higher risk of graft loss from any cause including death (hazard ratio, 1.39; 95% confidence interval, 1.08 to 1.79) and death censored allograft failure (hazard ratio, 1.78; 95% confidence interval, 1.27 to 2.49). In stratified analyses, the higher risk of graft loss among patients with cPRA ≥98% was only observed among repeat, but not first, transplant recipients. In subgroup analysis, there was no association between cPRA and graft loss among living related transplant recipients.

Conclusions Calculated panel reactive antibody is poorly associated with post-transplant immune reactivity to the allograft in the absence of donor-specific antibody.

Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_01_25_CJN13640820_final.mp3

  • transplant outcomes
  • acute rejection
  • risk factors
  • antibodies
  • Received August 19, 2020.
  • Accepted December 16, 2020.
  • Copyright © 2021 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 16 (2)
Clinical Journal of the American Society of Nephrology
Vol. 16, Issue 2
February 08, 2021
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Pretransplant Calculated Panel Reactive Antibody in the Absence of Donor-Specific Antibody and Kidney Allograft Survival
James H. Lan, Matthew Kadatz, Doris T. Chang, Jagbir Gill, Howard M. Gebel, John S. Gill
CJASN Feb 2021, 16 (2) 275-283; DOI: 10.2215/CJN.13640820

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Pretransplant Calculated Panel Reactive Antibody in the Absence of Donor-Specific Antibody and Kidney Allograft Survival
James H. Lan, Matthew Kadatz, Doris T. Chang, Jagbir Gill, Howard M. Gebel, John S. Gill
CJASN Feb 2021, 16 (2) 275-283; DOI: 10.2215/CJN.13640820
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