Immunosuppression Impacts Panel Reactive Antibody Status in Second Solid Organ Transplant Recipients - A Single Center Experience

Immunosuppression Impacts Panel Reactive Antibody Status in Second Solid Organ Transplant Recipients – A Single Center Experience

J. Patel¹, S. Ali², M. L. Sanders¹, C. P. Thomas¹, D. Axelrod¹, M. Bilal³, E. H. Field³, S. Kuppachi¹

¹University of Iowa Hospitals & Clinics, Iowa city, IA, ²Louis A. Johnson VA Medical Center, Clarksburg, WV, ³Iowa City VA Health Care System, Iowa city, IA

Meeting: 2021 American Transplant Congress

Abstract number: 661

Keywords: Kidney transplantation, Panel reactive antibodies, Retransplantation

Topic: Clinical Science » Biomarkers, Immune Assessment and Clinical Outcomes

Session Information

Session Name: Biomarkers, Immune Assessment and Clinical Outcomes

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Patients who require a second solid organ transplantation are significantly disadvantaged due to the event of sensitization due to the first transplant. We hypothesized that patients who remained on immunosuppression (IS) would have lower levels of calculated panel reactive antibodies (cPRA) prior to a second solid organ (kidney or pancreas) transplantation.

*Methods: We retrospectively analyzed cPRA levels in kidney transplant (KT) recipients at our center from January 2009 to December 2019 who had previously undergone a non-liver solid organ transplant (SOT). Patients with three or more transplants were excluded. We compared sensitization between those who remained on IS, and those who did not, based on cPRA, using odds ratio (OR) and Chi-square or Fisher’s exact test for statistical significance.

*Results: A total of 108 patients met the inclusion criteria. 88 had a prior KT, 12 simultaneous kidney-pancreas, 1 pancreas, 2 lung, and 5 heart before receiving their second solid organ transplant. In 44 out of 108 patients (40.7%), IS was continued before a kidney transplant. In 21 out of 44 patients (47.7%), cPRA was less than 20%, compared to 6 out of 64 patients (9.4%) in whom IS was discontinued. Even the percentage of highly sensitized patients (cPRA >80%) was significantly higher in patients who were not on IS (56.2%) compared to those who remained on IS (13.64%). The OR of having cPRA more than 20% was 8.8 (confidence interval 3.15-24.67) in patients who were not on IS. (Chi-square and Fisher exact p-value < .0001).

*Conclusions: In our single center analysis, patients who were not on any IS prior to a second solid organ transplant (kidney or pancreas) had a much higher risk of being sensitized compared to patients who were on IS. The number of highly sensitized patients (cPRA >80) was also significantly higher in those who were not on any IS. Additional prospective studies on a large scale are needed to confirm the benefit of the continuation of IS as well as the associated risk with an extended immunocompromised state.

Comparison of cPRA at second transplant in cases continuing verses stopping IS
cPRA at Second Transplant	<20 %	20-49 %	50-80 %	>80 %	Total
IS continued	21	8	9	6	44
IS stopped	6	9	13	36	64
	27	17	22	42	108

To cite this abstract in AMA style:

Patel J, Ali S, Sanders ML, Thomas CP, Axelrod D, Bilal M, Field EH, Kuppachi S. Immunosuppression Impacts Panel Reactive Antibody Status in Second Solid Organ Transplant Recipients – A Single Center Experience [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/immunosuppression-impacts-panel-reactive-antibody-status-in-second-solid-organ-transplant-recipients-a-single-center-experience/. Accessed May 8, 2025.

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