Calculated PRA: Initial Results Show Benefits for Sensitized Patients and a Reduction in Positive Crossmatches

Cecka, J. Michael; Kucheryavaya, Anna Y.; Reinsmoen, Nancy L.; Leffell, Mary S.

doi:10.1111/j.1600-6143.2010.03340.x

Cited by 155 publications

(96 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With the calculator available in 2007, the utilization of the cPRA in 2009 by the OPTN was designed to improve efficiency of allocation by reducing unexpected positive crossmatches and to ensure that cPRA was transparently reflective of the breadth of unacceptable antigens 14, 15, 16. In the development of the Canadian Blood Services Kidney Paired Donation Program and deceased donor Highly Sensitized Patient Program, the importance of cPRA to accurately prioritize patients was also recognized.…”

Section: Discussionmentioning

confidence: 99%

cPRA Increases With DQA, DPA, and DPB Unacceptable Antigens in the Canadian cPRA Calculator

Tinckam

Liwski

Pochinco

et al. 2015

American Journal of Transplantation

View full text Add to dashboard Cite

A calculated panel reactive antibody (cPRA) estimates the percentage of donors with unacceptable antigens (UA) for a recipient. cPRA may be underestimated in transplant candidates with UA to DQA, DPA, and DPB if these are not included in the calculation program. To serve the National Canadian Transplant Programs, a cPRA calculator was developed with complete molecular typing for all donors at HLA‐A, B, C, DRB1, DRB3/4/5, DQA1, DQB1, DPA1, and DPB1, all resolved to serologic equivalents. The prevalence of UA at DQA, DPA and DPB was evaluated in a sensitized regional population. The impact of adding these additional UA to cPRA was calculated alone and in combination, and compared to the baseline cPRA for UA at A, B, C, DR, DR51/52/53, and DQ. Of 740 sensitized transplant candidates, 18% of total and 32% with cPRA≥95% had DQA UA. Twenty‐seven percent of total and 54% with cPRA≥95% had DPB UA. Of 280/740 subjects with these UA, 36/280 (13%) had cPRA increase of >20% when they were included, 7% increased cPRA to ≥80% and 6% to ≥95%. Inclusion of DQA, DPA, and DPB UA in Canadian cPRA calculations improves the accuracy of cPRA where these are relevant in allocation.

show abstract

Section: Discussionmentioning

confidence: 99%

cPRA Increases With DQA, DPA, and DPB Unacceptable Antigens in the Canadian cPRA Calculator

Tinckam

Liwski

Pochinco

et al. 2015

American Journal of Transplantation

View full text Add to dashboard Cite

show abstract

“…Virtual crossmatching has now become the focal point of organ allocation in the United States and has clearly benefited recipients of deceased and living donor organs (18,27). It is also proving to be especially important for those patients involved in paired exchanges (28).…”

Section: Current and Anticipated Applicationsmentioning

confidence: 99%

“…This policy was designed not only to establish accountability and uniformity in reporting patient sensitization but also to improve the efficiency and logistics of kidney allocation by eliminating (or at least reducing) the frequency of incompatible organ offers. In actual practice, the policy reduced the likelihood of positive crossmatches for patients at the top of match run as well increased allocation to sensitized patients (18).…”

Section: Early Applicationsmentioning

confidence: 99%

“…The precise evaluation of HLA antibodies present in sera of sensitized patients coupled with objective identification of the HLA antigens expressed by organ donors defined the process of the vXM. The implementation of the vXM has facilitated local, regional and national solid organ allocation from both deceased and living donors (13,(15)(16)(17)(18) and has been particularly beneficial to highly sensitized patients, that is, those with panel reactive antibody (PRA) !80%.…”

Section: Revolutionmentioning

confidence: 99%

See 1 more Smart Citation

HLA Antibody Detection With Solid Phase Assays: Great Expectations or Expectations Too Great?

Gebel

Bray

2014

American Journal of Transplantation

135

101

View full text Add to dashboard Cite

Alloantibodies directed against HLA antigens, are a barrier to long-term solid organ allograft survival. The clinical impact of preformed, donor-directed HLA alloantibodies range from acceptable risk to unequivocal contraindication for organ transplantation. HLA antibodies are key factors that limit patient access to donor organs. Serological methods were once the only approach to identify HLA antigens and antibodies. Limitations in these technologies led to the development of solid phase approaches. In the early 1990s, the development of the polymerase chain reaction enabled DNA-based HLA antigen testing to be performed. By the mid-1990s, microparticle-based technology that utilized flow cytometry for analysis was developed to detect both classes I and II HLA antibodies. These methodologies revolutionized clinical histocompatibility testing. The strengths and weaknesses of these assays are described in detail in this review.

show abstract

“…Compelling studies demonstrated a strong correlation between a positive flow cytometric cross-match due to microparticle proven donor-specific Ab and early rejection and graft loss (30). The implementation of this new technology led to significant changes in allocation of solid organs to sensitized recipients throughout the United States (31).…”

Section: Cell Therapy and Transplantationmentioning

confidence: 99%

Translational Applications of Flow Cytometry in Clinical Practice

Jaye

Bray

Gebel

et al. 2012

The Journal of Immunology

100

View full text Add to dashboard Cite

Flow cytometry has evolved over the past 30 y from a niche laboratory technique to a routine tool used by clinical pathologists and immunologists for diagnosis and monitoring of patients with cancer and immune deficiencies. Identification of novel patterns of expressed Ags has led to the recognition of cancers with unique pathophysiologies and treatment strategies. FACS had permitted the isolation of tumor-free populations of hematopoietic stem cells for cancer patients undergoing stem cell transplantation. Adaptation of flow cytometry to the analysis of multiplex arrays of fluorescent beads that selectively capture proteins and specific DNA sequences has produced highly sensitive and rapid methods for high through-put analysis of cytokines, Abs, and HLA genotypes. Automated data analysis has contributed to the development of a “cytomics” field that integrates cellular physiology, genomics, and proteomics. In this article, we review the impact of the flow cytometer in these areas of medical practice.

show abstract

Calculated PRA: Initial Results Show Benefits for Sensitized Patients and a Reduction in Positive Crossmatches

Cited by 155 publications

References 9 publications

cPRA Increases With DQA, DPA, and DPB Unacceptable Antigens in the Canadian cPRA Calculator

cPRA Increases With DQA, DPA, and DPB Unacceptable Antigens in the Canadian cPRA Calculator

HLA Antibody Detection With Solid Phase Assays: Great Expectations or Expectations Too Great?

Translational Applications of Flow Cytometry in Clinical Practice

Contact Info

Product

Resources

About