Pretransplant Panel Reactive Antibodies in Human Lung Transplantation: An Analysis of Over 10,000 Patients

Ashish S. Shah, Lois Nwakanma, Christopher Simpkins, Jason Williams, David C. Chang, John V. Conte

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1919-1924
Number of pages6
JournalAnnals of Thoracic Surgery
Volume85
Issue number6
DOIs
StatePublished - Jun 1 2008

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Lung Transplantation
Antibodies
Lung
Survival
Transplants
Demography
Databases

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Shah, Ashish S. ; Nwakanma, Lois ; Simpkins, Christopher ; Williams, Jason ; Chang, David C. ; Conte, John V. / Pretransplant Panel Reactive Antibodies in Human Lung Transplantation : An Analysis of Over 10,000 Patients. In: Annals of Thoracic Surgery. 2008 ; Vol. 85, No. 6. pp. 1919-1924.
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abstract = "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.",
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Pretransplant Panel Reactive Antibodies in Human Lung Transplantation : An Analysis of Over 10,000 Patients. / Shah, Ashish S.; Nwakanma, Lois; Simpkins, Christopher; Williams, Jason; Chang, David C.; Conte, John V.

In: Annals of Thoracic Surgery, Vol. 85, No. 6, 01.06.2008, p. 1919-1924.

Research output: Contribution to journalArticle

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T1 - Pretransplant Panel Reactive Antibodies in Human Lung Transplantation

T2 - An Analysis of Over 10,000 Patients

AU - Shah, Ashish S.

AU - Nwakanma, Lois

AU - Simpkins, Christopher

AU - Williams, Jason

AU - Chang, David C.

AU - Conte, John V.

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