PRA Determination In Renal Transplantation Recipients

Objective Good tissue matching is one of the most important conditions of the renal transplant recipient long-term survive and kidney function resume after transplanting.The increasing of PRA straightly affected recent survival rate of graft. The detection of recipient PRA before and after surgery is very important, specially in the side of confining antibody quality in sensitive recipients. Our experiment have evaluated the HLA sensitivity status and HLA antibody specificity of the renal transplant recipients in order to select the appropriate donors and early diagnose hyper-acue rejection through detecting the variety of PRA. Methods With the use of Lambda Antigen Tray(LAT) , PRA level of 269 patients was measured.The patients who reach the hospital before Mar, 2000 were measured once in 1- week preoperation and the patients who reach the hospital after Mar, 2000 were measured besides in 1- week preoperation ,they were measured 1, 3, 5- day post-operation, were measured every week within one month and were measured every month within six monthes post-operation.The outcomes were analyzed through using LAT analyzing software. The evaluation standard was no sensitivity of PRA < 10%, lightlysensitivity of 10% < PRA < 50%, height sensitivity of PRA > 50%. Diagnosis of HAR or AR postoperative depended history, clinic symptom,physical sign,laboratory marker,color poppler ultrasonic, transplant kidney pathology andantirejection therapy effect. x~2 test through SPSSsoftware was adopted in statistics. Results The incidence of acute rejection after transplantation was 13. 2% in negative PRA group and was 46. 2% in positive PRA group. There was significant difference between the two groups (P<0. 001) . Of the 152 patients who were measured after Mar, 2000, the incidence of acute rejection was 9.5% in negative PRA pre-operation and post-operation, and was 60% in negative PRA preoperation and positive PRA post-operation. There was significantdifference between the two groups (P<0. 001). The incidence of positive PRA was 42% in 26 retransplantation patients and was 4% in first transplantation patients. Conclusion Along with the prevalence and development of renal transplantation, the increasing of sensitive candidates have already become the important agent influencing the survival of graft. Transfusion , pregnancy and first-transplants failure can stimulate recipient to produce HLA antibody. Thus the patients are at sensitization states. At present PRA level was adopted widely to evaluate the HLA sensitivity status of the renal transplant recipient internationally. PRA was considered one of the five most important factors influeucing graft long-term survival rate, even more than tissue matching. This test had discovered that the incidence of acute rejection after transplantation was obviously higher in the PRA positive recipientsthan in the PRA negative recipients. The PRA level before theoperation notably affected rejection of transplantedkidney. Detecting HLA antibody and selecting the appropriaterecipient are very important for estimateing the conditions oftransplant rejection, graft survival and the function of graftrecovering. High PRA recipients were cautious to treat in ourhospital, and surgery was done as PRA level was declined throughwaiting or treatment. Katznelson have confirmed that increasing ofAR incidence was related to the increasing of PRA level. The sharplyincreasing of PRA which was more early occurred than the clinicsymptoms indicated the happening of rejection. Our test discoveredthat the AR incidence was 9. 5% in PRA negative pre-operation andpostoperation and the AR incidence was 60% in PRA negativepreoperation and PRA positive postoperation. PRA levelposttransplantation influenced AR, thus AR can be early diagnosedand treated through monitoring the changes of PRA level. There wassignificant difference between the incidence of PRA positive inretransplantion patients and first transplantion patients. The risrate of rejection was more higher in the retransplantion patientsthan first transplantion patients .The produce of anti-donorspecific antibody proved that the graft was one of the bodysensitization risk factors. To rise the survival rate of graft, weshould select matching HLA tissue matching, at the same time, shouldapply IVAG plasma exchange immunity adsorption and improveimmunosuppression program to reduce rejection rate. To evaluate theHLA sensitivity status and the HLA antibody specificity of the renal...