Comparison of panel-reactive antibody levels in caucasian and african american renal transplant candidates

PRA levels from 58 Caucasian and 70 African American ESRD patients were compared against a panel of cryopreserved lymphocytes from 60 donors (40 Caucasian, 15 African American, 5 others) to determine whether there was significant racial influence on PRA outcome. African Americans were found to have significantly higher mean PRA levels than Caucasians (27% vs. 18%, P=0.02). Restricting this analysis to only 1° transplant candidates showed predictably lower mean PRAs: 6% in Caucasians and 15% in African Americans, but the difference between the two groups remained significant (P=0.015). The percentage of patients with PRA≥10% was also greater among African Americans than Caucasians (43% vs. 24%, P=0.026). For patients not previously transplanted, the difference between these frequencies remained significant: 11% in Caucasians, 30% in African Americans (P=0.025). Untransplanted African American patients with positive PRAs (≥10%) had significantly higher PRA against African American cell donors (mean = 55%) than against Caucasian cell donors (mean = 44%) (mean difference = 10.6%, P=0.0056). African Americans were more frequently transfused than Caucasians. The percentage of patients not previously transplanted receiving 0, 1-5, and >5 transfusions were 69%, 22%, and 9% for Caucasians and 43%, 44%, and 13% for African Americans (P=0.03). This higher transfusion rate is the most likely contributor to the elevated PRA levels observed in African Americans.