Original scientific paper

https://doi.org/10.20471/acc.2023.62.02.02

Determination of the PRA Positivity Percentage in Male Patients with Chronic Kidney Disease by Using Flow Cytometry Technique

Fatma Avcı Merdin orcid.org/0000-0003-4753-1354 ; Akdeniz University Hospital, Department of Internal Medicine, Antalya, Turkey *
Hüseyin Koçak ; Akdeniz University Hospital, Department of Internal Medicine, Division of Nephrology, Antalya, Turkey
Sadi Köksoy ; Akdeniz University Hospital, Department of Immunology, Antalya, Turkey

* Corresponding author.

Abstract

The antibodies directed against human leukocyte antigen (HLA) molecules, which play
a crucial role in allograft histocompatibility, are called anti-HLA antibodies. Anti-HLA antibodies against
foreign HLA molecules may be present in patients with chronic kidney disease even before transplantation.
The panel reactive antibody (PRA) test is used to measure the renal transplant candidate’s immune sensitivity
to HLA molecules other than their own HLA molecules by assessing the diversity of anti-HLA antibodies
in the blood of these patients. This study aimed to determine the PRA values and the percentage of PRA
positivity of Turkish male patients with chronic kidney disease (CKD), who had not been sensitized by the
major known causes (those with no history of organ or tissue transplantation, those with no history of blood
transfusion), who had not been diagnosed with any autoimmune diseases, and who had not been under immunosuppressive
treatment. The study included 60 male patients aged over 18 years. All of the patients were
followed up with a diagnosis of CKD at the Nephrology Clinic, Internal Medicine Department, Akdeniz
University Medical Faculty Hospital. None of the patients included in the study was sensitized by a known
mechanism previously (they did not have blood transfusion or organ transplantation). Glomerular filtration
rate (GFR) levels of all patients were below the level of 60 mL/min/1.73 m2. Patient data including their
age information, etiology of CKD, accompanying diseases, and information about dialysis modalities were
recorded. HLA antibody percentage was determined by the flow cytometry technique. Statistical data analysis
was performed by using SPSS 22.0 (Statistical Package for Social Sciences, Version 22.0). The values of p less
than 0.05 were considered statistically significant. Twenty patients were receiving dialysis treatment due to
end-stage renal disease. Of the 60 patients included in the study, 25% showed PRA positivity; 28.3% of all
study patients were found to be positive for anti-HLA class I antibodies and 26.7% of all study patients were
found to be positive for anti-HLA class II antibodies on separate analysis for anti-HLA class I and anti-HLA
class II antibody positivity. When the patients were categorized as PRA negative and PRA positive in two
groups, there were no differences between the groups according to mean age, percentage of hemodialysis
patients, percentage of peritoneal dialysis patients and presence of accompanying chronic diseases (such as
hypertension, type 2 diabetes mellitus, hyperlipidemia, nephrolithiasis, coronary artery disease). In addition to
this, evaluation of the GFR levels showed that the PRA positive group contained a significantly higher percentage
of end-stage renal disease patients (GFR <15 mL/min/1.73 m2) as compared with the PRA negative
group. Detailed analysis of the percentages of PRA levels in the PRA positive patients, which was carried out
to determine the degree of sensitization, showed that the PRA values were over 80% in 11.77% of the patients
positive for anti-HLA class I antibodies. On the other hand, PRA values were within the range of 15%-80%
in 88.23% of the patients who had anti-HLA class II antibodies. The PRA values were below 80% in all of the
patients positive for anti-HLA class II antibodies and those positive for both anti-HLA class I and class II
antibodies. In conclusion, PRA levels of the candidates for kidney transplantation should always be measured
to assess their state of sensitization before transplantation, even though they have no risk factors known to
cause anti-HLA antibody development.

Keywords

Chronic kidney disease; Flow cytometry; Anti-HLA antibodies; Renal transplantation

Hrčak ID:

308627

URI

https://hrcak.srce.hr/308627

Publication date:

1.8.2023.

Article data in other languages: croatian

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