*Purpose: To evaluate the clinical efficacy and safety of iguratimod (IGU) for reducing panel reactive antibody (PRA) in high mismatched renal transplant recipients.

*Methods: Eligible recipients found positive PRA with or without IGU administered were enrolled. Propensity score matching (PSM) analysis was conducted to eliminate the difference between the IGU group and the No IGU group. After adjustment, MFI changes of PRA before and after drug treatment between the two groups were assessed. Adverse reactions or side effects were also reviewed.

*Results: 54 recipients were included eventually after 1:1 matching analysis. 340 and 144 PRA sites were detected in the IGU group and the No IGU group, respectively. The proportion of PRA sites with decreased MFI was obviously higher in the IGU group than in the No IGU group. After IGU taken for 9 months, significantly MFI decrease was seen in anti-HLA class I, anti-HLA class II, anti-HLA class I and class II, anti-HLA A, anti-HLA B, anti-HLA Cw, anti-HLA DQ and anti-HLA DR antibody sites (P <0.05), except of anti-HLA DP antibody sites (P >0.05). Decrease of PRA in the IGU group was greater than in the No IGU group in anti-HLA class I, anti-HLA class II, anti-HLA class I and class II, anti-HLA A, anti-HLA DR antibody sites (P <0.05), except in anti-HLA Cw, anti-HLA DP and anti-HLA DQ antibody sites (P >0.05). Adverse reactions or side effects was identical between the two groups (P >0.05).

*Conclusions: IGU can effectively reduce PRA in high mismatched renal transplant recipients and can be applied safely without serious adverse effects.

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