BACKGROUND: The effect of pretransplant sensitization on outcome after cardiac transplant has been controversial. Sensitization, defined as a positive panel-reactive antibody (PRA) screen in patients awaiting transplant, represents circulating antibodies to a random panel of donor lymphocytes (usually T lymphocytes). The significance of pretransplant circulating antibodies to B lymphocytes has not been reported, and many centers disregard its use. METHODS AND RESULTS: We retrospectively reviewed the pretransplant PRA screens for 311 patients who underwent cardiac transplant at our institution. The PRA screen was performed by use of the lymphocytotoxic technique treated with dithiothreitol to remove IgM autoantibodies. Patients with PRA > or = 11% against T or B lymphocytes had significantly lower 3-year survival (T lymphocytes, 39%; B lymphocytes, 56%) than those patients with PRA = 0% and PRA = 1% to 10% (T lymphocytes, 76% and 78%; B lymphocytes, 78% and 74%, respectively) (P < .001). For this high-risk group, the rejection episode tended to occur earlier than in those patients with PRA = 0% and PRA = 1% to 10% (T lymphocytes, 2.3 versus 4.0 and 3.8 months; B lymphocytes, 2.1 versus 4.1 and 3.4 months, respectively), and there were more clinically severe rejections that required OKT3 therapy. CONCLUSIONS: Cardiac transplant patients with pretransplant T- and/or B-lymphocyte PRA > or = 11% despite negative donor-specific crossmatch at the time of transplant appear to have earlier and more severe rejection with significantly lower survival after transplant surgery. Modification of immunosuppression in these high-risk patients may be warranted.
BACKGROUND: The effect of pretransplant sensitization on outcome after cardiac transplant has been controversial. Sensitization, defined as a positive panel-reactive antibody (PRA) screen in patients awaiting transplant, represents circulating antibodies to a random panel of donor lymphocytes (usually T lymphocytes). The significance of pretransplant circulating antibodies to B lymphocytes has not been reported, and many centers disregard its use. METHODS AND RESULTS: We retrospectively reviewed the pretransplant PRA screens for 311 patients who underwent cardiac transplant at our institution. The PRA screen was performed by use of the lymphocytotoxic technique treated with dithiothreitol to remove IgM autoantibodies. Patients with PRA > or = 11% against T or B lymphocytes had significantly lower 3-year survival (T lymphocytes, 39%; B lymphocytes, 56%) than those patients with PRA = 0% and PRA = 1% to 10% (T lymphocytes, 76% and 78%; B lymphocytes, 78% and 74%, respectively) (P < .001). For this high-risk group, the rejection episode tended to occur earlier than in those patients with PRA = 0% and PRA = 1% to 10% (T lymphocytes, 2.3 versus 4.0 and 3.8 months; B lymphocytes, 2.1 versus 4.1 and 3.4 months, respectively), and there were more clinically severe rejections that required OKT3 therapy. CONCLUSIONS: Cardiac transplant patients with pretransplant T- and/or B-lymphocyte PRA > or = 11% despite negative donor-specific crossmatch at the time of transplant appear to have earlier and more severe rejection with significantly lower survival after transplant surgery. Modification of immunosuppression in these high-risk patients may be warranted.
Authors: Jon A Kobashigawa; Jignesh K Patel; Michelle M Kittleson; Matt A Kawano; Krista K Kiyosaki; Stephanie N Davis; Jaime D Moriguchi; Elaine F Reed; Abbas A Ardehali Journal: Clin Transplant Date: 2010-10-25 Impact factor: 2.863
Authors: H Haddad; D Isaac; J F Legare; P Pflugfelder; P Hendry; M Chan; B Cantin; N Giannetti; S Zieroth; M White; W Warnica; K Doucette; V Rao; A Dipchand; M Cantarovich; W Kostuk; R Cecere; E Charbonneau; H Ross; N Poirier Journal: Can J Cardiol Date: 2009-04 Impact factor: 5.223
Authors: Warren A Zuckerman; Adriana Zeevi; Kristen L Mason; Brian Feingold; Carol Bentlejewski; Linda J Addonizio; Elizabeth D Blume; Charles E Canter; Anne I Dipchand; Daphne T Hsu; Robert E Shaddy; William T Mahle; Anthony J Demetris; David M Briscoe; Thalachallour Mohanakumar; Joseph M Ahearn; David N Iklé; Brian D Armstrong; Yvonne Morrison; Helena Diop; Jonah Odim; Steven A Webber Journal: Am J Transplant Date: 2018-03-23 Impact factor: 8.086
Authors: Stavros G Drakos; Abdallah G Kfoury; John R Kotter; Bruce B Reid; Stephen E Clayson; Craig H Selzman; Josef Stehlik; Patrick W Fisher; Mario Merida; David D Eckels; Kim Brunisholz; Benjamin D Horne; Sandi Stoker; Dean Y Li; Dale G Renlund Journal: J Heart Lung Transplant Date: 2009-08 Impact factor: 10.247
Authors: Kevin P Daly; Stephanie F Chandler; Christopher S Almond; Tajinder P Singh; Helen Mah; Edgar Milford; Gregory S Matte; Heather J Bastardi; John E Mayer; Francis Fynn-Thompson; Elizabeth D Blume Journal: Pediatr Transplant Date: 2013-08-06