BACKGROUND: The presence of antibodies to human leukocyte antigens (HLA) prior to transplantation has been linked to worse post-transplant outcomes in many solid organ transplants. The effect of these antibodies is less clear in lung transplant recipients, although previous studies have suggested an increased incidence of allograft dysfunction. METHODS: A retrospective study of all first lung transplant recipients from the University of Toronto (November 1983-July 2001, n = 380) and Duke University (April 1992-June 2000, n = 276) was performed. Demographic data, survival information, and level of last pre-transplant panel reactive antibody (PRA) were collected. PRA level was measured by the complement-dependent cell cytotoxicity assay at both centers. Survival analysis was performed using the Kaplan-Meier method, and groups were compared with the Wilcoxon rank sum test. RESULTS: Of 656 lung transplant recipients, 101 (15.4%) had a PRA greater than 0, 37 (5.6%) had a PRA greater than 10%, and 20 (3.0%) had a PRA greater than 25%. Patients with a PRA greater than 25% had decreased median survival than did the rest of the patients (1.5 vs 5.2 years) and at 1 month (70% vs 90%), 1 year (65% vs 76%), and 5 years (31% vs 50%), respectively (p = 0.006, Wilcoxon's rank sum test) test). CONCLUSION: Significant elevation of PRA prior to lung transplantation is associated with worse survival, especially in the early post-transplant period. This may be due to a direct effect of anti-HLA antibodies on the allograft. The effectiveness of treatments such as plasmapheresis and intravenous immunoglobulin prior to transplantation needs to be evaluated.
BACKGROUND: The presence of antibodies to human leukocyte antigens (HLA) prior to transplantation has been linked to worse post-transplant outcomes in many solid organ transplants. The effect of these antibodies is less clear in lung transplant recipients, although previous studies have suggested an increased incidence of allograft dysfunction. METHODS: A retrospective study of all first lung transplant recipients from the University of Toronto (November 1983-July 2001, n = 380) and Duke University (April 1992-June 2000, n = 276) was performed. Demographic data, survival information, and level of last pre-transplant panel reactive antibody (PRA) were collected. PRA level was measured by the complement-dependent cell cytotoxicity assay at both centers. Survival analysis was performed using the Kaplan-Meier method, and groups were compared with the Wilcoxon rank sum test. RESULTS: Of 656 lung transplant recipients, 101 (15.4%) had a PRA greater than 0, 37 (5.6%) had a PRA greater than 10%, and 20 (3.0%) had a PRA greater than 25%. Patients with a PRA greater than 25% had decreased median survival than did the rest of the patients (1.5 vs 5.2 years) and at 1 month (70% vs 90%), 1 year (65% vs 76%), and 5 years (31% vs 50%), respectively (p = 0.006, Wilcoxon's rank sum test) test). CONCLUSION: Significant elevation of PRA prior to lung transplantation is associated with worse survival, especially in the early post-transplant period. This may be due to a direct effect of anti-HLA antibodies on the allograft. The effectiveness of treatments such as plasmapheresis and intravenous immunoglobulin prior to transplantation needs to be evaluated.
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: S Samuel Weigt; Ariss DerHovanessian; W Dean Wallace; Joseph P Lynch; John A Belperio Journal: Semin Respir Crit Care Med Date: 2013-07-02 Impact factor: 3.119
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: L D Snyder; A L Gray; J M Reynolds; G M Arepally; A Bedoya; M G Hartwig; R D Davis; K E Lopes; W E Wegner; D F Chen; S M Palmer Journal: Am J Transplant Date: 2014-02-19 Impact factor: 8.086