Sensitization to HLA antigens creates an obstacle for the accessibility and success of kidney transplantation (KT). Highly sensitized patients have longer waiting times and some may never receive a KT. Aim: To determine the risk and probability of patients on the deceased donor (DD) waiting list to receive a KT based on the panel reactive antibody percentage (PRA%). Methods: The DD waiting list from our institution was analyzed from 01/05 to 08/12 documenting the clinical variables from donor and potential recipients (blood group [BG]), lymphocyte cross-match [CxM (CDC-AHG)] results, highest PRA% determination, and time on the waiting list. The patients were classified into 4 groups based on the PRA%: 0%, 1-19%, 20-79% and 80-100%. The data was analyzed using odds ratio and logistic regression (significant p<0.05). Results: 58 DD: F/M 34:24, BG O=35, A=13, B= 10, and 179 potential recipients were analyzed: >18 yrs, F/M 98:81, BG O=127, A=33, B=19, participating 4.2±3.8 times with different donors to receive KT. The mean PRA was 22±32%, median [M] 0 (0-98). A total of 83 patients received KT (mean waiting time 2.2±1.7 yrs, 12d-7yrs) and their mean PRA% was 11.6±24 M 0 (0-94) vs. 31.4±37 M 8.5 (0-98) in those who have not received a KT. An association between the PRA% and KT (p<0.006) was observed. The probability of receiving KT with a 0% PRA vs. >0% was 100% higher (OR 2.12). There was no difference between the 0% vs. 1-19% group (OR 1); 0% vs. 20-79% (OR 2.5) and 0% vs. 80-100% (OR 5). For every percent increase in the PRA above 20%, the risk of not receiving a KT increased by 5% (1-9, p<0.01). Conclusions: The probability of receiving a DD kidney transplant is inversely related to the PRA% although a higher risk for not receiving a KT becomes evident with a PRA >20%.

Figure 1. Proportion of deceased donor KT between PRA% groups from 2005-2012.

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