Effect of recipient sensitization (peak PRA) on graft outcome in haploidentical living related kidney transplants

Objective. To evaluate the influence of pre-transplant recipient sensitizat ion on the outcome of 1-haploidentical live related donor (LRD) kidney tran splants. Method. We reviewed 141 consecutive cyclosporine-treated adult haploidentic al first transplants for which panel reactive antibody (PRA) levels were av ailable. Patients were divided into three groups according to their peak PR A levels: group I, PRA = 0 (n = 97); group II, PRA = 1-50% (n = 24), and gr oup III, PRA = 51-100% (n = 20). Results. Differences in PRA were associated with significant differences in short- and longer-term graft survival, unrelated to patient survival. Graf t survival at 1. 3, and 5 yr was only 74, 40, and 27% in group III, compare d to 92. 87, and 52% in group II, and 96, 91, and 85% in group I (p < 0.001 ). Increasing PRA was associated with shorter time-to-graft failure. In gro up III, 20% lost their transplant from acute rejection in the first 6 month s, versus 4% in group II and 3% in group I (p < 0.01). Graft survival in gr oup II diverged from that of group I only after 3 yr, due to an increase in loss from chronic rejection. Hospitalization was longer in group III, in a ssociation with a significantly higher incidence of acute rejection during the first 3 months after transplantation (p < 0.02). Serum creatinine was h igher in sensitized than nonsensitized patients at all time points. Conclusions. Sensitization has a significant negative impact on the outcome of haploidentical LRD kidney transplants. Sensitized potential recipients and their potential donors should be aware of this in arriving at informed decision-making for transplantation. These patients may benefit from more s ensitive cross-match testing, more intense or more novel immunosuppression. or immunomodulation to modify their immune responsiveness.