Risk factors of sensitization to human leukocyte antigen in end-stage renal disease patients

Abstract

Background: Pre-sensitization to human leukocyte antigen (HLA) is closely related to the prognosis of renal transplantation. Concerning the risk factors for HLA sensitization, most studies focused only on selected transplant candidates.

Methods: All patients with end-stage renal disease (ESRD) in a single teaching hospital and a group of healthy subjects were enrolled for the tests of panel-reactive antibodies (PRA).

Results: A total of 1177 subjects were recruited, including 289 ESRD patients (140 hemodialysis, 98 peritoneal dialysis, and 51 pre-dialysis) and 888 healthy volunteers. The prevalence of PRA positivity (for either type I or II HLA) for ESRD patients was higher than for healthy subjects (23.2% vs. 12.8%, p=0.000). Only pregnancy and transfusion showed independent correlations with PRA positivity, and not ESRD itself. The PRA-positive ESRD patients were prone to be female, have histories of pregnancy, transfusion, no hepatitis B, and use of graft shunt for dialysis. Multivariate analyses showed that pregnancy and time interval of the latest transfusion had independent correlations with PRA positivity. The time interval of less than 1 year had the highest odds ratio 10.06 (p=0.000).

Conclusions: Pregnancy and recent transfusion, not ESRD itself or dialysis modality, remain the independent risk factors for HLA sensitization.

Keywords: Dialysis; End-stage renal disease; Human leukocyte antigen; Kidney transplantation; Panel-reactive antibody.