Calculated PRA: Initial results show benefits for sensitized patients and a reduction in positive crossmatches

J. M. Cecka, A. Y. Kucheryavaya, N. L. Reinsmoen, M. S. Leffell

Research output: Contribution to journalArticle

Abstract

The calculated panel reactive antibody (CPRA), which is based upon unacceptable HLA antigens listed on the waitlist form for renal transplant candidates, replaced PRA as the measure of sensitization among US renal transplant candidates on October 1, 2009. An analysis of the impact of this change 6 months after its implementation shows an 83% reduction in the number of kidney offers declined nationwide because of a positive crossmatch. The increasing acceptance and utilization of unacceptable HLA antigens to avoid offers of predictably crossmatch-positive donor kidneys has increased the efficiency of kidney allocation, resulting in a significant increase in the percentage of transplants to broadly sensitized (80+% PRA/CPRA) patients from 7.3% during the period 07/01/2001-6/30/2002 to 15.8% of transplants between 10/1/09-3/31/10. The transplant rates per 1000 active patient-years on the waitlist also increased significantly for broadly sensitized patients after October 1, 2009. These preliminary results suggest that 'virtual' positive crossmatch prediction based on contemporary tools for identifying antibodies directed against HLA antigens is effective, increases allocation efficiency and improves access to transplants for sensitized patients awaiting kidney transplantation.

Original languageEnglish (US)
Pages (from-to)719-724
Number of pages6
JournalAmerican Journal of Transplantation
Volume11
Issue number4
DOIs
StatePublished - Apr 1 2011

Keywords

  • Crossmatching
  • HLA antibodies
  • highly sensitized
  • histocompatibility
  • kidney allocation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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