Pretransplant panel reactive antibodies in human lung transplantation: an analysis of over 10,000 patients.
BACKGROUND
The role of panel reactive antibody (PRA) in lung transplant recipients has not been clearly defined in a large population. We sought to determine how panel reactive antibody level affects survival in lung transplant recipients.


METHODS
The United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research files from 1987 through 2005 were analyzed. Demographic data, pretransplant PRA, relevant clinical indicators, and survival were examined.


RESULTS
Of the 12,751 first lung transplant recipients during this period, pretransplant PRA levels were reported for 10,237 patients. Panel reactive antibody was more than 0% in 1748 patients; of these, PRA was 1% to 10% in 1259 (72%), 11% to 25% in 249 (14%), and more than 25% in 240 (14%). Using the Kaplan-Meier method, survival decreased with increasing PRA and was significant when PRA exceeded 25% compared with the rest of the cohort. On multivariable analysis, PRA was associated with increased 30-day (hazard ratio, 2.6) and overall mortality (hazard ratio, 1.3). Importantly, this effect was not seen when a cohort from 1998 through 2005 was analyzed.


CONCLUSIONS
The UNOS database has provided the largest series of lung transplant patients stratified by PRA. Our analysis demonstrates that PRA level exceeding 25% is a predictor of death. However, newer laboratory and management techniques may attenuate this effect with better outcomes in the modern era.
Shah
Ashish S
AS
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Medical Institute, Baltimore, Maryland 21287, USA. ashah29@jhmi.edu
Nwakanma
Lois
L
Simpkins
Christopher
C
Williams
Jason
J
Chang
David C
DC
Conte
John V
JV
D000206:Actuarial Analysis; D000328:Adult; D003601:Cytotoxicity Tests, Immunologic; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality*; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000276:immunology / Q000401:mortality*; D011300:Preoperative Care; D011379:Prognosis; D012042:Registries
D006680:HLA Antigens; D007518:Isoantibodies