Vancouver Coastal Health Research Institute, Vancouver, Canada.
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
Clin J Am Soc Nephrol. 2021 Feb 8;16(2):275-283. doi: 10.2215/CJN.13640820. Epub 2021 Jan 25.
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.
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.
Calculated panel reactive antibody is poorly associated with post-transplant immune reactivity to the allograft in the absence of donor-specific antibody.
This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_01_25_CJN13640820_final.mp3.
Panel reactive antibody（群体反应性抗体）可提示移植候选者找到 HLA 相容供体的可能性，但由于检测方法无法排除同时存在供体特异性抗体，因此该抗体与急性排斥反应和移植物存活相关。尽管有新的方法可以排除供体特异性抗体，但仍在使用 panel reactive antibody 来确定诱导和维持免疫抑制的选择。本研究的目的是在不存在供体特异性抗体的情况下确定 panel reactive antibody 的临床相关性。
设计、地点、参与者和测量方法：对 4058 例零 HLA-A、B、DR 和 DQB1 错配且无针对这些 HLA 基因座编码的供体肾抗原的抗体的移植受者的肾移植存活率进行回顾性观察性研究。
在 4058 例首次和重复移植受者中，与 cPRA 为 0%的患者相比，cPRA 为 1%-97%的患者移植失败的风险并未增加（死亡校正移植物丢失：风险比，1.07；95%置信区间，0.82 至 1.41）。cPRA≥98%的患者发生任何原因（包括死亡）的移植物丢失风险更高（风险比，1.39；95%置信区间，1.08 至 1.79）和死亡校正移植物失败（风险比，1.78；95%置信区间，1.27 至 2.49）。分层分析显示，cPRA≥98%的患者移植物丢失风险增加仅见于重复而非首次移植受者。在亚组分析中，cPRA 与活体亲属供体移植受者的移植物丢失之间没有关联。
在不存在供体特异性抗体的情况下，计算的 panel reactive antibody 与移植物的移植后免疫反应性相关性较差。
本文包含一个播客，可在 https://www.asn-online.org/media/podcast/CJASN/2021_01_25_CJN13640820_final.mp3 上找到。
