BACKGROUND: Panel-reactive antibody (PRA) is used to estimate the degree of humoral sensitization in the recipient before transplantation. Although pretransplant sensitization is associated with increased complications in other solid organ transplant recipients, less is known about the outcome of sensitized lung transplant recipients. Therefore, we sought to determine the impact of elevated pretransplant PRA on clinical outcomes after lung transplantation. METHODS: The records of the first 200 lung transplant operations performed at Duke University Medical Center were reviewed. The outcomes of sensitized patients, PRA greater than 10% before transplantation (n = 18), were compared with the outcomes of nonsensitized patients. RESULTS: Sensitized patients experienced a significantly greater number of median ventilator days posttransplant (9 +/- 8) as compared with nonsensitized recipients (1 +/- 11; p = 0.0008). There were no significant differences between the number of episodes of acute rejection; however, there was a significantly increased incidence of bronchiolitis obliterans syndrome occurring in untreated sensitized recipients (56%) versus nonsensitized (23%; p = 0.044). In addition, there was a trend towards decreased survival in the sensitized recipients, with a 2-year survival of 58% in sensitized recipients as compared with 73% in the nonsensitized patients (p = 0.31). CONCLUSIONS: Sensitized lung transplant recipients experience more acute and chronic complications after transplantation. These patients probably warrant alternative management strategies.
BACKGROUND: Panel-reactive antibody (PRA) is used to estimate the degree of humoral sensitization in the recipient before transplantation. Although pretransplant sensitization is associated with increased complications in other solid organ transplant recipients, less is known about the outcome of sensitized lung transplant recipients. Therefore, we sought to determine the impact of elevated pretransplant PRA on clinical outcomes after lung transplantation. METHODS: The records of the first 200 lung transplant operations performed at Duke University Medical Center were reviewed. The outcomes of sensitized patients, PRA greater than 10% before transplantation (n = 18), were compared with the outcomes of nonsensitized patients. RESULTS: Sensitized patients experienced a significantly greater number of median ventilator days posttransplant (9 +/- 8) as compared with nonsensitized recipients (1 +/- 11; p = 0.0008). There were no significant differences between the number of episodes of acute rejection; however, there was a significantly increased incidence of bronchiolitis obliterans syndrome occurring in untreated sensitized recipients (56%) versus nonsensitized (23%; p = 0.044). In addition, there was a trend towards decreased survival in the sensitized recipients, with a 2-year survival of 58% in sensitized recipients as compared with 73% in the nonsensitized patients (p = 0.31). CONCLUSIONS: Sensitized lung transplant recipients experience more acute and chronic complications after transplantation. These patients probably warrant alternative management strategies.
Authors: Laneshia K Tague; Chad A Witt; Derek E Byers; Roger D Yusen; Patrick R Aguilar; Hrishikesh S Kulkarni; Karen Bennett Bain; Keith A Fester; Varun Puri; Daniel Kreisel; Thalachallour Mohanakumar; Elbert P Trulock; Ramsey R Hachem Journal: Ann Am Thorac Soc Date: 2019-07
Authors: James P Bosanquet; Chad A Witt; Bradford C Bemiss; Derek E Byers; Roger D Yusen; Alexander G Patterson; Daniel Kreisel; Thalachallour Mohanakumar; Elbert P Trulock; Ramsey R Hachem Journal: J Heart Lung Transplant Date: 2015-06-10 Impact factor: 10.247
Authors: Laurie D Snyder; Ziwei Wang; Dong-Feng Chen; Nancy L Reinsmoen; C Ashley Finlen-Copeland; W Austin Davis; David W Zaas; Scott M Palmer Journal: Chest Date: 2013-07 Impact factor: 9.410
Authors: David C Neujahr; Adriana C Cardona; Onome Ulukpo; Mark Rigby; Andres Pelaez; Allan Ramirez; Anthony A Gal; Seth D Force; E Clinton Lawrence; Allan D Kirk; Christian P Larsen Journal: Transplantation Date: 2009-08-27 Impact factor: 4.939
Authors: Takekazu Iwata; Alexander Philipovskiy; Amanda J Fisher; Robert G Presson; Masako Chiyo; Jae Lee; Elizabeth Mickler; Gerald N Smith; Irina Petrache; David B Brand; William J Burlingham; Bagavathi Gopalakrishnan; Daniel S Greenspan; Jason D Christie; David S Wilkes Journal: J Immunol Date: 2008-10-15 Impact factor: 5.422