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The Pre-Transplant Drop in Panel-Reactive Antibodies Titer Evaluated Using Complement-Dependent Cytotoxicity (PRA-CDC) and the Risk of Early Acute Rejection in Sensitized Kidney Transplant Recipients

1
Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Francuska 20, 40-037 Katowice, Poland
2
Department of Nephrology, Transplantation and Internal Medicine, Medical University of Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland
3
Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, Reymonta 8, 40-027 Katowice, Poland
*
Author to whom correspondence should be addressed.
Received: 1 August 2018 / Revised: 11 September 2018 / Accepted: 18 September 2018 / Published: 20 September 2018
Background: The panel-reactive antibodies that use the complement-dependent cytotoxicity test (PRA-CDC) are still a standard method for monitoring the degree of immunization in kidney transplant candidates on active waiting lists in some countries, including Poland. The aim of this study was to analyze the relationship between the maximum and the last pre-transplant PRA titer on the percentage of positive cross-matches and rate of early acute rejection episodes. Material and methods: The retrospective analysis included 528 patients from two transplant centers. All patients were divided into three groups, depending on their peak and last pre-transplant PRA titers. There were 437 (82.8%) patients with peak PRA <20% (non-sensitized group, non-ST) and 91 (17.2%) patients with peak PRA >20%. Among the latter group, 38 had maintained PRA level >20% at the time of transplantation (sensitized patients, ST), whereas 53 had pre-transplant PRA ≤20% (previously sensitized patients, prev-ST). Results: The percentages of positive crossmatches were 76.9% in ST and 53.7% in prev-ST groups versus 18.4 in non-ST group (both p < 0.001). The acute rejection rates were 18.9, 17.6 and 6.8%, respectively (p < 0.001 for ST or prev-ST versus non-ST). The pre-transplant PRA titer drop did not decrease the risk of early acute rejection [OR = 1.09 (95% CI: 0.31–3.85)] in a multiple logistic regression analysis. The occurrences of primary graft non-function and delayed graft function were similar in all study groups. Conclusions: Previously immunized kidney transplant candidates even with substantial decrease in pre-transplant PRA-CDC levels are still at high immunological risk when compared with non-immunized patients, and they should receive lymphocyte-depleting induction therapy. View Full-Text
Keywords: acute rejection; immunization; panel-reactive antibodies; positive cross-match; waiting list acute rejection; immunization; panel-reactive antibodies; positive cross-match; waiting list
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MDPI and ACS Style

Kolonko, A.; Bzoma, B.; Giza, P.; Styrc, B.; Sobolewski, M.; Chudek, J.; Dębska-Ślizień, A.; Więcek, A. The Pre-Transplant Drop in Panel-Reactive Antibodies Titer Evaluated Using Complement-Dependent Cytotoxicity (PRA-CDC) and the Risk of Early Acute Rejection in Sensitized Kidney Transplant Recipients. Medicina 2018, 54, 66. https://0-doi-org.brum.beds.ac.uk/10.3390/medicina54050066

AMA Style

Kolonko A, Bzoma B, Giza P, Styrc B, Sobolewski M, Chudek J, Dębska-Ślizień A, Więcek A. The Pre-Transplant Drop in Panel-Reactive Antibodies Titer Evaluated Using Complement-Dependent Cytotoxicity (PRA-CDC) and the Risk of Early Acute Rejection in Sensitized Kidney Transplant Recipients. Medicina. 2018; 54(5):66. https://0-doi-org.brum.beds.ac.uk/10.3390/medicina54050066

Chicago/Turabian Style

Kolonko, Aureliusz, Beata Bzoma, Piotr Giza, Beata Styrc, Michał Sobolewski, Jerzy Chudek, Alicja Dębska-Ślizień, and Andrzej Więcek. 2018. "The Pre-Transplant Drop in Panel-Reactive Antibodies Titer Evaluated Using Complement-Dependent Cytotoxicity (PRA-CDC) and the Risk of Early Acute Rejection in Sensitized Kidney Transplant Recipients" Medicina 54, no. 5: 66. https://0-doi-org.brum.beds.ac.uk/10.3390/medicina54050066

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