Influence of panel-reactive antibodies on posttransplant outcomes in lung transplant recipients.
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.
Lau
C L
CL
Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Palmer
S M
SM
Posther
K E
KE
Howell
D N
DN
Reinsmoen
N L
NL
Massey
H T
HT
Tapson
V F
VF
Jaggers
J J
JJ
D'Amico
T A
TA
Davis
R D
RD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood*; D000917:Antibody Formation; D001989:Bronchiolitis Obliterans / Q000209:etiology; D002648:Child; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007114:Immunization; D007902:Length of Stay; D016040:Lung Transplantation / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D012122:Ventilators, Mechanical
D000906:Antibodies