Significance of panel reactive antibodies in patients requiring kidney transplantation.

Presence of antibodies against human leukocyte antigen (HLA) molecules, which may be may be directed against HLA class I or/and class II antigens, is a known risk factor for acute rejections and graft loss. Pre-transplantation panel reactive antibody (PRA) estimation is done to identify sensitized patients prior to solid organ transplantation and also forms the basis of cadaver organ allocation. The aim of this study is to evaluate the PRA in 52 patients awaiting first renal transplant, identify various factors contributing to high PRA, and observe its influence on graft survival. This was a case control study performed in a tertiary care hospital. Eighty-five samples including 63 from 52 patients with end-stage renal disease (ESRD), 10 from healthy volunteers, and 12 from presumed sensitized individuals were tested for class I and/or II PRA by enzyme-linked immunosorbent assay (ELISA) using Quik ID ® GTI kits. PRA for both class I and II was zero in all healthy controls and 19/46 (37%) patient samples; while individually, PRA class I and II were zero in 32/60 (53%) and 39/45 (86.3%) samples, respectively. PRA exceeded 10% in 16 samples from 12 patients with peak class I and II PRA of 100% and 46%, respectively. Post-transplantation, 27/31 patients are doing well, while four died with a functioning graft. Patient reactivity to antigen stimulation is the most important factor determining the PRA levels, and class I PRA is more relevant for detection of sensitization in first-time recipients and adversely affects the graft outcome.