Purposes: This study was conducted to investigate the impact of pre-transplant PRA level on rejection and graft survival after kidney transplantation in patients with negative cross-match and no donor specific antibody(DSA).Methods and Materials: This is retrospectively 513 kidney recipients transplanted at our center from January 2009 to April 2013. And among them, those who identified positive test on cross-match, those who had donor specific antibodies, ABO incompatible, and those who had no information of PRA were excluded(n=130). The clinical characteristic was analyzed. Peak PRA was stratified into 3 groups according to their PRA levels group I, PRA=0; group II, PRA< 50%, and group III, PRA>50%. Results: Among 433 study population,347(80.1%) group I; 55(12.7%) group II ; 31(7.2%) group III. The rejection rate was 20.1% (group I 18.5% vs. group II 23.8% vs. group III 33.3% (p=.053)). The graft failure rate was 21.7%(group I 6.4% vs. group II 7.1% vs. group III 7.4% (p=.792)). Univariate analysis by log-rank test, donor source and rejection were significantly associated with graft survival(p=0.000 and 0.000, respectively). On multivariate Cox regression analysis, donor source and rejection were also significantly associated with graft survival(p<.05 and p<.05, respectively), however including subcatergories of PRA(p=.552).Conclusions: The rate of rejection showed strong trend to significant, as PRA group increases(p=.053). Pre-transplant PRA value was not significantly associated with graft survival, in patients with CXM(-) and DSA(-). However, donor source and presence of rejection were significantly associated with graft failure.

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