Transplant Nephrectomy After Allograft Failure Is Associated With Allosensitization

OBJECTIVES To evaluate the effect of transplant nephrectomy (TN) on the percentage of panel reactive antibody (%PRA) and donor-specific antibody (DSA) levels in patients with renal allograft failure. METHODS The records of patients with failed kidney transplants, who had undergone TN from 2000 to 2007, were reviewed. The pre- and post-TN serum samples were available for analysis from 31 patients. Human leukocyte antigen typing and the %PRA was measured in these patients using standard serologic techniques. The pre- and post-TN patient serum samples were evaluated for DSA levels using solid phase assays and single antigen beads. The pre- and post-TN measurements of the %PRA and DSA levels were compared using the Wilcoxon signed rank test, and the associated clinical variables were identified on multivariate regression analysis. RESULTS The mean %PRA increased from 33.4 to 75.6 for class I antigens (P < .001) and from 38.9 to 60.6 (P = .002) for class II antigens in patients before and after TN, respectively. This increase was associated with an increase in the mean human leukocyte antigen class I and class II DSA levels from 33 518 molecular equivalents of soluble fluorochrome (MESF) to 121 457 MESF (P < .001) and from 45 459 MESF to 126 968 MESF (P < .001), respectively. Regression analysis showed that rejection episodes and an interval from graft failure to TN of <10 months were associated with greater increases in the mean %PRA (P < .001) and mean DSA levels (P = .02). CONCLUSIONS The results of the present study have confirmed that the %PRA increases after TN in patients with renal allograft failure, and sensitization occurs after TN, with an increase in DSA levels. Rejection episodes and early TN after graft failure might result in a greater degree of sensitization. UROLOGY 78: 314-318, 2011. (C) 2011 Elsevier Inc.