Original articles: General thoracic
Influence of panel-reactive antibodies on posttransplant outcomes in lung transplant recipients

Presented at the Forty-sixth Annual Meeting of the Southern Thoracic Surgical Association, San Juan, Puerto Rico, Nov 4–6, 1999.
https://doi.org/10.1016/S0003-4975(00)01224-8Get rights and content

Abstract

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.

Section snippets

Material and methods

We retrospectively reviewed the records of the first 200 lung transplant operations (performed at Duke University Medical Center between November 1992 and December 1998) and identified all patients with a PRA screen of greater than 10% before transplantation. The technique for determining PRA during this study was the complement-dependent cell cytotoxicity (CDC) test. Briefly, a panel of T-cell-enriched lymphocytes from donors of known HLA types is screened with recipient sera using the

Results

Clinical outcomes are shown in Table 1. Of the 200 lung transplants performed between November 1992 and December 1998, 18 (9%) were in patients with at least one pretransplant PRA screen of greater than 10%. The mean PRA, donor, and recipient ages, gender, race, and underlying disease of sensitized and nonsensitized patients are shown in Table 2.

Comment

Decreased kidney graft survivals have been reported in recipients with pretransplant circulating antibodies 10, 11. In cardiac transplants, Kobashigawa and colleagues [5] found elevated PRA correlated with decreased 3-year survival, earlier episodes of rejection, and more severe rejections. In liver transplants, elevated PRA correlated with early severe rejection episodes and graft failure [2].

In comparison, Gammie and colleagues [6] found elevated PRA did not predict decreased survival or the

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