DefinePK

Research Objective

To determine the association of panel reactive antibodies (PRA) with complement-dependent cytotoxicity (CDC) cross-match in Pakistani pre-renal transplant recipients.

Methodology

Cross-sectional study conducted at the Immunology Department, Armed Forces Institute of Pathology, Rawalpindi, from October 2017 to October 2018. 162 patients with end-stage renal disease awaiting renal transplantation were included. Serum samples were collected for PRA detection using microbead array (Luminex) and for CDC cross-match using donor blood and patient serum. Data analysis involved frequency and percentage calculations, and the chi-square test was applied to determine associations.

Methodology Flowchart

                        graph TD;
    A["Patient Recruitment n=162"] --> B["Informed Consent & History"];
    B --> C["Serum Sample Collection for PRA"];
    B --> D["Donor Blood & Patient Serum for CDC Cross-match"];
    C --> E["PRA Detection via Luminex"];
    D --> F["CDC Cross-match Performance"];
    E --> G["Data Analysis"];
    F --> G;
    G --> H["Frequency & Percentage Calculation"];
    G --> I["Chi-Square Test for Association"];
    H --> J["Results Interpretation"];
    I --> J;
    J --> K["Conclusion & Recommendations"];                    

Discussion

The study highlights the strong association between PRA and CDC cross-match in pre-renal transplant recipients in Pakistan, a region with limited data on this topic. The findings suggest that while CDC cross-match is a crucial test, it can yield false results and lacks the detection of anti-MIC antibodies, which are involved in graft rejection. The higher PRA positivity in females, potentially linked to multiparity and blood transfusions, is noted. The study emphasizes the need for routine use of both PRA and CDC cross-match in renal transplant workup.

Key Findings

Panel reactive antibodies (PRA) were present in 48 patients (30%), and complement-dependent cytotoxicity (CDC) cross-match was positive in 16 patients (10%). In male recipients (n=141), 25% were positive for PRA and 7% had positive CDC cross-match. In female recipients (n=21), 62% were positive for PRA and 28% had positive CDC cross-match. CDC cross-match and PRA were strongly associated (p<0.001). No significant association was found between CDC cross-match and anti-MIC antibodies (p<0.013). Patients positive for both CDC cross-match and PRA had an average mean fluorescent intensity (MFI) of more than 4000.

Conclusion

Complement-dependent cytotoxicity (CDC) cross-match and panel reactive antibodies (PRA) should be routinely performed in patients undergoing renal transplants. Relying solely on CDC cross-match can lead to false negative or false positive results, and it fails to detect anti-MIC antibodies that contribute to graft rejection.

Fact Check

1. PRA was present in 48 out of 162 patients, which is 30%. (Confirmed)
2. CDC cross-match was positive in 16 out of 162 patients, which is 10%. (Confirmed)
3. The association between CDC cross-match and PRA was found to be statistically significant with a p-value of <0.001. (Confirmed)

Mind Map