title: Influence of race/ethnic differences in pre-transplantation panel reactive antibody on outcomes in heart transplant recipients.
abstract: OBJECTIVE
  This study sought to investigate post-transplantation outcomes as a function of race and panel reactive antibody (PRA).
  
  
  BACKGROUND
  PRA screening is used to determine the presence of pre-formed antibodies to population-wide human leukocyte antigens (HLAs) in patients being evaluated for heart transplantation (HT). Racial/ethnic differences in long-term survival after HT have been described. However, whether there are significant racial/ethnic differences in PRA among adults awaiting HT is poorly characterized.
  
  
  METHODS
  We identified patients age ≥18 years in the Organ Procurement and Transplantation database with race/ethnicity of white, black, Hispanic, or Asian and listed for HT between 2000 and 2012 (N = 19,704). A PRA value of ≥10% was used to define clinically meaningful sensitization.
  
  
  RESULTS
  Blacks had a higher peak PRA than did all other groups and were more likely to be sensitized. Black HT recipients were more likely to experience graft failure than were Hispanic, white, and Asian recipients (31% vs. 27%, 26%, and 21%, respectively; p < 0.001). The median follow-up was 1,207 days (interquartile range: 373 to 2,364 days), with a trend toward a shorter median time to graft failure in the Asian group than in the black, Hispanic, and white groups (p = 0.065). Sensitized blacks had the lowest rate of allograft survival, whereas nonsensitized Asians had the highest survival. Using Cox proportional regression to adjust for other clinical variables, black race (HR: 1.3; 95% confidence interval [CI]: 1.2 to 1.5), Hispanic ethnicity (HR: 1.2; 95% CI: 1.0 to 1.5), and sensitization (HR: 1.2; 95% CI: 1.1 to 1.4) remained predictors of higher rates of graft failure.
  
  
  CONCLUSIONS
  Race/ethnicity and level of sensitization are important predictors of graft survival.
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia. Electronic address: aamorr3@emory.edu.
authors.forename: Alanna A
authors.initials: AA
authors.lastname: Morris
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Cole
authors.affiliation: Emory University School of Public Health, Atlanta, Georgia.
authors.forename: Emir
authors.initials: E
authors.lastname: Veledar
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Naveen
authors.initials: N
authors.lastname: Bellam
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: S Raja
authors.initials: SR
authors.lastname: Laskar
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Smith
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Howard M
authors.initials: HM
authors.lastname: Gebel
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bray
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000208:ethnology / Q000276:immunology; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D016027:Heart Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D016016:Proportional Hazards Models; D044469:Racial Groups / Q000706:statistics & numerical data*; D014481:United States; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies
keywords: BMI; HLA; HT; PRA; SES; VAD; body mass index; heart transplant; human leukocyte antigen; panel reactive antibody; race/ethnicity; socioeconomic status; ventricular assist device