Calculated PRA: Initial Results Show Benefits for Sensitized Patients and a Reduction in Positive Crossmatches
Calculated PRA: Initial Results Show Benefits for Sensitized Patients and a Reduction in Positive Crossmatches
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DOI：
10.1111/j.1600-6143.2010.03340.x
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发表时间：
2011-04-01
影响因子：
8.8
通讯作者：
Leffell, M. S.
中科院分区：
文献类型：
--
作者：
Cecka, J. M.;Kucheryavaya, A. Y.;Leffell, M. S.
根据肾移植候选人等待名单上列出的不可接受的HLA抗原计算的群体反应性抗体（CPRA）于2009年10月1日取代PRA作为美国肾移植候选人中致敏性的衡量标准。对这一变化实施6个月后的影响进行的分析显示，由于交叉配型阳性，全国肾脏供应数量减少了83%。越来越多的人接受和利用不可接受的HLA抗原来避免提供可预测的交叉配型阳性供体肾脏，这提高了肾脏分配的效率，导致广泛致敏的移植百分比显著增加，（80+% PRA/CPRA）患者从2001年7月1日至2002年6月30日期间的7.3%增加到2009年10月1日至2010年3月31日期间的15.8%。在2009年10月1日之后，对于广泛致敏的患者，等待名单上每1000活跃患者年的移植率也显著增加。这些初步结果表明，“虚拟”阳性交叉配型预测的基础上，当代工具，用于识别针对HLA抗原的抗体是有效的，提高分配效率，并提高获得移植的致敏患者等待肾移植。
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.