My brother is awaiting a second kidney transplant. His first transplant was 7 years back. Dr’s are saying his PRA levels are very high. He has HLA Class I PRA -7% and HLA Class II PRA -91% (tests done in Feb 2017) What are options to reduce PRA and can continuous dialysis for some more time reduce PRA? He started dialysis again in Feb this year and he had few blood transfusions in Jan & feb this year.

Panel reactive antibodies (PRA’s) are immune proteins in the blood that are non-specifically directed against potential kidney donors.  In some cases, the exact Human Lymphocyte Antigen (HLA) type can be detected, but in some cases, we do not know the exact antigen that is reacting with the antibody.  The antibodies are generally caused by prior blood transfusion and prior transplantation.  This appears to be the case for your brother.  Reducing the PRA’s is not an easy task.  There have been many attempts using apheresis separation techniques, immunoabsorption, intravenous immune gamma globulin infusion and very sophisticated techniques of immunosuppression, but most reports are mixed results.   Conventional hemodialysis does not remove or reduce PRA’s.  In most cases, it is necessary to just wait for the right kidney to come along that is matched to your brother, but this can take some time.  I suggest that your brother discuss the PRA testing with his transplant nephrologist.

 

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