Lim Wai H, Chapman Jeremy R, Wong Germaine
1 Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. 2 Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia. 3 Sydney School of Public Health, University of Sydney, New South Wales, Australia. 4 Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia.
Transplantation. 2015 May;99(5):1043-50. doi: 10.1097/TP.0000000000000469.
High levels of pretransplant panel reactive antibodies (PRA) are known to be associated with detrimental effects on graft outcomes, but the association between pretransplant PRA levels and long-term patient outcomes is unclear.
Using the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), we assessed the risk of rejection, graft failure, mortality and cancer in kidney transplant recipients with varying peak PRA levels.
In 7,118 kidney transplant recipients between 1997 and 2009, there were a total of 3,171 (44.6%), 3,306 (46.4%), 323 (4.5%), and 318 (4.5%) recipients with peak PRA levels of 0%, 1% to 50%, 51% to 80%, and greater than 80%, respectively. Compared to recipients with 0% peak PRA level, recipients with peak PRA levels greater than 80% were at increased risk of acute rejection (odds ratio, 1.81, 95% confidence interval [95% CI], 1.30-2.35; P < 0.001), death censored graft failure (hazard ratio [HR], 2.06; 95% CI, 1.46-2.91; P < 0.001), all-cause mortality (HR, 1.56; 95% CI, 1.15-2.11; P < 0.001) and cancer (HR, 1.94; 95% CI, 1.26-2.97; P = 0.002) in the adjusted models independent of human leukocyte antigen mismatches and initial immunosuppression.
Highly sensitized kidney transplant recipients with peak PRA greater than 80% had a greater risk of rejection, graft failure, cancer and death independent of age and time on dialysis. Strategies to reduce transplant waiting time and avoidance of sensitization in all potential transplant candidates are imperative to improve the overall graft and patient survival.
已知移植前群体反应性抗体（PRA）水平较高与移植结果的有害影响相关，但移植前PRA水平与患者长期预后之间的关联尚不清楚。
利用澳大利亚和新西兰透析与移植登记处（ANZDATA）的数据，我们评估了不同峰值PRA水平的肾移植受者发生排斥反应、移植失败、死亡和患癌的风险。
在1997年至2009年期间的7118例肾移植受者中，峰值PRA水平分别为0%、1%至50%、51%至80%和大于80%的受者总数分别为3171例（44.6%）、3306例（46.4%）、323例（4.5%）和318例（4.5%）。与峰值PRA水平为0%的受者相比，峰值PRA水平大于80%的受者在独立于人类白细胞抗原错配和初始免疫抑制的校正模型中，发生急性排斥反应的风险增加（比值比，1.81；95%置信区间[95%CI]，1.30 - 2.35；P < 0.001），死亡审查的移植失败风险增加（风险比[HR]，2.06；95%CI，1.46 - 2.91；P < 0.001），全因死亡风险增加（HR，1.56；95%CI，1.15 - 2.11；P < 0.001），患癌风险增加（HR，1.94；95%CI，1.26 - 2.97；P = 0.002）。
峰值PRA大于80%的高度致敏肾移植受者，在不考虑年龄和透析时间的情况下，发生排斥反应、移植失败、患癌和死亡的风险更高。减少移植等待时间以及避免所有潜在移植候选者致敏的策略对于提高总体移植和患者生存率至关重要。
