Pre-transplant panel reactive antibody in lung transplant recipients is associated with significantly worse post-transplant survival in a multicenter study.
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).


CONCLUSIONS
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.
Department of Medicine, Division of Respirology, Toronto General Hospital, Toronto, Ontario, Canada.
Denis
D
Hadjiliadis
Cecilia
C
Chaparro
Nancy L
NL
Reinsmoen
Carlos
C
Gutierrez
Lianne G
LG
Singer
Mark P
MP
Steele
Thomas K
TK
Waddell
Robert D
RD
Davis
Michael A
MA
Hutcheon
Scott M
SM
Palmer
Shaf
S
Keshavjee
D000328:Adult; D000906:Antibodies / Q000097:blood*; D001788:Blood Grouping and Crossmatching; D003601:Cytotoxicity Tests, Immunologic; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D006333:Heart Failure / Q000276:immunology; D006801:Humans; D016040:Lung Transplantation / Q000276:immunology* / Q000401:mortality*; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000276:immunology; D011658:Pulmonary Fibrosis / Q000276:immunology; D012189:Retrospective Studies
D000906:Antibodies; D006680:HLA Antigens