BACKGROUND: Sensitized candidates with unacceptable antigens are a group that demands special attention in organ transplantation. Calculated panel reactive antigen (cPRA) is not used to modify allocation priorities in lung transplantation. The impact of cPRA on waiting list time and mortality is unknown. METHODS: We performed a retrospective review of candidates for lung transplantation listed from May 2005 to 2018. Data from the Organ Procurement and Transplantation Network/United Network for Organ Sharing STAR (Standard Analysis and Research) dataset was paired with additional unacceptable human leukocyte antigen (UA-HLA) data, which were used to calculate the listing cPRA. Candidates were stratified based on the lack of UA-HLAs or cPRA level for candidates with unacceptable antigens reported. Unadjusted competing risks and adjusted subdistribution hazard models were fit. RESULTS: A total of 29,085 candidates met inclusion criteria for analysis. Of these, 23,562 (81%) with no UA-HLAs, 3472 (11.9%) with a cPRA less than 50, and 2051 with a cPRA greater than or equal to 50 (7.1%). On adjusted analysis, a cPRA greater than or equal to 50 was independently associated with increased waitlist mortality at 1 year (hazard ratio, 1.71; 95% confidence interval, 1.55-1.88; P < .001) and decreased rate of transplantation (71.9% vs 69.5% vs 44.4%; P < .001). Furthermore, patients with a cPRA greater than or equal to 50 had a longer waitlist time compared with a cPRA less than 50 and no UA-HLA candidates (mean 293.69 days vs 162.38 days and 143.26 days, respectively; P < .001). However, once transplanted, posttransplant survival among the cohorts was similar. CONCLUSIONS: Further evaluation of organ allocation with consideration of a candidate's cPRA may be warranted in order to optimize equity in access to transplants.
BACKGROUND: Sensitized candidates with unacceptable antigens are a group that demands special attention in organ transplantation. Calculated panel reactive antigen (cPRA) is not used to modify allocation priorities in lung transplantation. The impact of cPRA on waiting list time and mortality is unknown. METHODS: We performed a retrospective review of candidates for lung transplantation listed from May 2005 to 2018. Data from the Organ Procurement and Transplantation Network/United Network for Organ Sharing STAR (Standard Analysis and Research) dataset was paired with additional unacceptable human leukocyte antigen (UA-HLA) data, which were used to calculate the listing cPRA. Candidates were stratified based on the lack of UA-HLAs or cPRA level for candidates with unacceptable antigens reported. Unadjusted competing risks and adjusted subdistribution hazard models were fit. RESULTS: A total of 29,085 candidates met inclusion criteria for analysis. Of these, 23,562 (81%) with no UA-HLAs, 3472 (11.9%) with a cPRA less than 50, and 2051 with a cPRA greater than or equal to 50 (7.1%). On adjusted analysis, a cPRA greater than or equal to 50 was independently associated with increased waitlist mortality at 1 year (hazard ratio, 1.71; 95% confidence interval, 1.55-1.88; P < .001) and decreased rate of transplantation (71.9% vs 69.5% vs 44.4%; P < .001). Furthermore, patients with a cPRA greater than or equal to 50 had a longer waitlist time compared with a cPRA less than 50 and no UA-HLA candidates (mean 293.69 days vs 162.38 days and 143.26 days, respectively; P < .001). However, once transplanted, posttransplant survival among the cohorts was similar. CONCLUSIONS: Further evaluation of organ allocation with consideration of a candidate's cPRA may be warranted in order to optimize equity in access to transplants.
Authors: Don Hayes; Bryan A Whitson; Samir N Ghadiali; Joseph D Tobias; Heidi M Mansour; Sylvester M Black Journal: Lung Date: 2015-07-29 Impact factor: 2.584
Authors: John D Smith; Mohamed W Ibrahim; Helen Newell; Anna J Danskine; Simona Soresi; Margaret M Burke; Marlene L Rose; Martin Carby Journal: J Heart Lung Transplant Date: 2014-05-17 Impact factor: 10.247
Authors: M Valapour; C J Lehr; M A Skeans; J M Smith; K Uccellini; R Lehman; A Robinson; A K Israni; J J Snyder; B L Kasiske Journal: Am J Transplant Date: 2019-02 Impact factor: 8.086
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: Chad A Witt; Joseph P Gaut; Roger D Yusen; Derek E Byers; Jennifer A Iuppa; K Bennett Bain; G Alexander Patterson; Thalachallour Mohanakumar; Elbert P Trulock; Ramsey R Hachem Journal: J Heart Lung Transplant Date: 2013-08-13 Impact factor: 10.247
Authors: William T Mahle; Margaret A Tresler; R Erik Edens; Paolo Rusconi; James F George; David C Naftel; Robert E Shaddy Journal: J Heart Lung Transplant Date: 2011-08-06 Impact factor: 10.247
Authors: Natasha Aleksova; Ana C Alba; Chun-Po S Fan; Brigitte Mueller; Lisa M Mielniczuk; Ross A Davies; Ellamae Stadnick; Heather J Ross; Sharon Chih Journal: J Heart Lung Transplant Date: 2018-12-21 Impact factor: 10.247
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
Authors: David M Vock; Michael T Durheim; Wayne M Tsuang; C Ashley Finlen Copeland; Anastasios A Tsiatis; Marie Davidian; Megan L Neely; David J Lederer; Scott M Palmer Journal: Ann Am Thorac Soc Date: 2017-02