Differential Impact of Class I and Class II Panel Reactive Antibodies on Post-Heart Transplant Outcomes
Section snippets
Patient Population
We performed a retrospective analysis of UNOS Organ Procurement and Transplantation Network registry of all adult patients (age ≥18 years) who underwent orthotopic heart transplantation between 2004 and 2015. Class I and class II PRA levels were being systematically reported from 2004. Patients with prior heart transplantation were excluded from the study. Of this cohort, both class I and class II PRA levels were reported in 17,361 patients and these patients were included in the study.
Given
Patient Population and PRA
Baseline characteristics of the patients are shown in Table 1. The median age of the cohort was 56 years (interquartile range 46–62 years) with 25% of the cohort being female. The median time on the waitlist was 83 days (interquartile range 24–234 days), and a significant number (85.6%) had >4 HLA mismatches.
The frequency of patients in each of the PRA groups was 88% for group 1, 3% for group 2, 6% for group 3, and 3% for group 4. Thus, 12% of transplanted patients were sensitized against class
Discussion
Currently, the relationship between pretransplant elevation in class I and class II PRA and post-heart transplant outcomes is unclear. To our knowledge this is the first report evaluating the differential impact of elevated class I and class II PRA on outcomes in heart transplant recipients. We found that, although sensitized patients are at risk for waiting longer on the waitlist, their post-transplant risk for poor outcomes seems to increase mainly in those patients who have combined
Conclusions
Combined elevation of class I and class II PRA is associated with increased risk of adverse outcomes such as treated rejection at one-year and all-cause mortality. Among this, the increased risk of treated rejection was driven by class I PRA and increased mortality driven by class II PRA. Hence, an integrated analysis of both PRAs provides superior information regarding clinically relevant outcomes.
All the authors contributed to conception and interpretation of data. JBIM and LB drafted of the
Declaration of Competing Interest
None
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