title: The impact of pre-transplant allosensitization on outcomes after lung transplantation.
abstract: BACKGROUND
  Allosensitization can be a significant barrier to transplantation for some patients, and previous studies suggested that pre-transplant allosensitization was associated with worse outcomes after lung transplantation. However, human leukocyte antigen (HLA) antibody testing has evolved significantly over the past 10 years, and current assays are highly sensitive and specific.
  
  
  METHODS
  We examined the impact of pre-transplant allosensitization on post-transplant outcomes in the era of solid-phase multiplex HLA antibody detection assays in this retrospective, single-center study of 304 adult transplant recipients between January 1, 2006, and December 31, 2012. We accepted donor organs for allosensitized patients if a virtual crossmatch was compatible with all previously identified antibodies.
  
  
  RESULTS
  In univariate and multivariate Cox proportional hazards models, pre-transplant allosensitization, the calculated panel reactive antibody, and the number of pre-transplant HLA antibodies were not associated with the development of acute cellular rejection, lymphocytic bronchiolitis, donor-specific HLA antibodies, chronic lung allograft dysfunction, or graft failure.
  
  
  CONCLUSIONS
  Pre-transplant allosensitization does not adversely affect outcomes after lung transplantation when the potentially reactive HLAs are avoided in the donor by a virtual crossmatch with the recipient.
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: James P
authors.initials: JP
authors.lastname: Bosanquet
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Witt
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Bradford C
authors.initials: BC
authors.lastname: Bemiss
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Derek E
authors.initials: DE
authors.lastname: Byers
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Yusen
authors.affiliation: Division of Cardiothoracic Surgery.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Patterson
authors.affiliation: Division of Cardiothoracic Surgery.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kreisel
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Thalachallour
authors.initials: T
authors.lastname: Mohanakumar
authors.affiliation: Division of Pulmonary and Critical Care Medicine.
authors.forename: Elbert P
authors.initials: EP
authors.lastname: Trulock
authors.affiliation: Division of Pulmonary and Critical Care Medicine. Electronic address: Rhachem@dom.wustl.edu.
authors.forename: Ramsey R
authors.initials: RR
authors.lastname: Hachem
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007114:Immunization / Q000379:methods*; D015994:Incidence; D007518:Isoantibodies / Q000276:immunology*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D066027:Transplant Recipients
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies
keywords: allosensitization; lung transplantation; panel reactive antibody