Association Between Panel-reactive Antibody Positivity and Platelet Indices in Kidney Transplant Candidates

Panel-reactive antibody (PRA) is an established marker of pre-transplant immunological sensitization; however, the relationship between PRA positivity and routinely measured platelet indices remains unclear. The present retrospective observational study investigated the association between PRA positivity and platelet count, as well as indices, in adult kidney transplant candidates. Following the screening of 450 candidates, 208 were deemed eligible after excluding patients with active infection, those using medications affecting platelet indices, or those for whom simultaneous PRA and complete blood count measurements were unavailable. The demographic, laboratory, and immunological data of all participants were recorded. Of these, 58 (27.9%) were classified as PRA-positive (PRA >10%) and 150 (72.1%) as PRA-negative (PRA ≤10%). The cohort comprised 114 women (54.8%) and 94 men (45.2%). Compared with PRA-negative patients, PRA-positive patients had a higher proportion of women (77.6% vs. 46.0%; p < 0.001), longer median dialysis duration (51.5 [28.5–85.0] vs. 26.0 [2.75–50.25] months; p < 0.001), and higher median platelet distribution width (PDW; 16.45 [16.07–16.90] vs. 16.20 [15.80–16.60] fL; p = 0.006). However, platelet count, mean platelet volume, and plateletcrit were comparable. In multivariable analysis, female sex, longer dialysis duration, peritoneal dialysis, and higher PDW values were independently associated with PRA positivity, although the absolute difference between the PRA-positive and PRA-negative groups was small (16.45 vs. 16.20 fL). Higher PDW was associated with PRA positivity in kidney transplant candidates; however, the small between-group difference and the observational design preclude conclusions regarding its clinical utility. Further prospective studies are required to confirm this association.