1.7
#46
ALLOGRAFT NEPHRECTOMY AND PRA: A CASE STUDY.
Prem Kumar M.D. , Beena Arora MS , Phillip Boudreaux M.D. , Daniel Frey M.D. , T. Ramcharan M.D. and Kathleen Wiley M.S. . New Orleans LA, LSU Health Sciences Center, 70112, Department of Medicine and New Orleans LA, Transplant Institute of New Orleans, 70119 .

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There is still some controversy in the literature about the removal of a transplantated kidney which is no longer functioning. Due to the mortality and morbidity associated with surgery, current policy in most Transplant Centers is to leave nonfunctioning grafts in place unless they are causing complications in the recipients. There is little information regarding the relationship between PRA levels and allograft nephrectomy. We report on a patient who had a 0% PRA after graft loss but developed donor specific antibodies after nephrectomy of the non-functioning renal allograft.
A 45 year old African American female ( A28,30;B35,53;DR 13,18;) received a 5 antigen mismatched cadaveric donor kidney (A1,31;B47,49: DR11,13;) in 12/98. The patient’s pretransplant PRA was 0% (CDC method). The transplanted kidney was lost due to chronic rejection in December of 2001. The patient was re-listed in January of 2002. Monthly antibody screening (ELISA) results were 0%. A nephrectomy of the transplanted kidney was performed in November of 2002 The next monthly ELISA antibody screen was positive. The ELISA ID result was 95% with the A1 CREG specificity identified. . The CDC/AHG PRA results were 40% with an A1 specificity. Subsequent monthly screens (ELISA) have remained positive with donor HLA directed A1 specificity detected.
We conclude from this case that the transplanted kidney acted as a sponge and absorbed the donor specific antibodies. This patient is now listed on the cadaveric waiting list with A1 identified as an unacceptable antigen