The Journal of Heart and Lung Transplantation
Pre-Transplant Panel Reactive Antibody in Lung Transplant Recipients is Associated with Significantly Worse Post-Transplant Survival in a Multicenter Study
Section snippets
Methods
A retrospective study was performed at the University of Toronto and at Duke University Medical Center. Patients receiving a second lung transplant were excluded because of the confounding effect related to the increased likelihood of an elevated PRA and worse outcomes compared with first transplants.
There were 380 first lung transplants performed at the University of Toronto between November 1983 and July 2001. All patients received post-operative immunosuppression with cyclosporine A,
Results
During the study period, 656 first lung transplants were performed at the 2 institutions. Of these 656, 101 patients (15.4%) had a PRA greater than zero before transplant, 37 patients (5.6%) had a PRA greater than 10%, and 20 patients (3.0%) had a PRA greater than 25%, which was chosen as the cutoff for a positive result in this study. Their characteristics can be seen in Table 1. The mean PRA of patients with values higher than 25% was 49.5% ± 14.9%. The median value for these patients was
Discussion
Elevated PRA levels, as measured by the CDC-AHG method, are not very common in lung transplant recipients. In renal transplantation, 25% to 50% of patients on the waiting list have a PRA level higher than 20%,30 while 5.5% of heart transplant recipients had high PRA levels before transplant.17 Gender was not predictive of a higher PRA level; however, the relatively small number of patients might have decreased the ability of this study to detect any gender effects on elevated PRA. CDC-AHG is
References (34)
- et al.
Pulmonary transplantation for cystic fibrosispre-transplant recipient characteristics in patients dying of peri-operative sepsis
J Heart Lung Transplant
(2003) - et al.
Weight gain after lung transplantation
J Heart Lung Transplant
(2003) - et al.
Acute and chronic pleural complications in lung transplantation
J Heart Lung Transplant
(2003) - et al.
Emergence of ganciclovir-resistant cytomegalovirus in lung transplant recipients
J Heart Lung Transplant
(2002) - et al.
Nutritional assessment of the lung transplant patientbody mass index as a predictor of 90-day mortality following transplantation
J Heart Lung Transplant
(2001) - et al.
Prognostic value of serum carcinoembryonic antigen levels in patients who undergo lung transplantation
J Heart Lung Transplant
(2001) - et al.
Cytomegalovirus antibody status of donor/recipient does not influence the incidence of bronchiolitis obliterans syndrome in lung transplantation
J Heart Lung Transplant
(2003) - et al.
A positive donor gram stain does not predict outcome following lung transplantation
J Heart Lung Transplant
(2002) - et al.
Pre-transplant mechanical ventilation and outcome in patients with cystic fibrosis
J Heart Lung Transplant
(2003) - et al.
Influence of panel-reactive antibodies on posttransplant outcomes in lung transplant recipients
Ann Thorac Surg
(2000)
Mycobacterial infections in lung transplant recipients
Chest
Rabbit antithymocyte globulin decreases acute rejection after lung transplantationresults of a randomized, prospective study
Chest
Immunologic sensitization in recipients of left ventricular assist devices
J Thorac Cardiov Surg
Lung transplantation
N Engl J Med
The registry of the International Society for Heart and Lung Transplantationtwentieth official lung and heart-lung transplant report—2003
J Heart Lung Transplant
Bronchiolitis obliterans after lung transplantationa review
Chest
Anti-HLA antibodies after solid organ transplantation
Transplantation
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Lung transplantation despite preformed donor-specific antihuman leukocyte antigen antibodies: a 9-year single-center experience
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2022, Transplant ImmunologyCitation Excerpt :Due to the fact that individual research groups receive different results in their cohorts, there are no defined cut-off values of the PRA or MFI threshold for recognizing anti-HLA antibodies that would affect the transplant success [1,30,45,46]. Bear in mind that we do not have as strong data supporting this fact in the case of lung transplants as in the case of other solid organ transplants [1,2,19,38,47–49]. British Society for Histocompatibility and Immunogenetics (BISHI) in the document: ‘Guidelines for the detection and characterization of clinically relevant antibodies in allotransplantation’ proposed that, in the case of thoracic organ transplantation, the presence of DSA antibodies of 5000 MFI and above, should be a contraindication for transplantation, apart from exceptional cases, and values between 2000 and 5000 MFI, indicate minimum risk of hyperacute rejection due to low level donor HLA specific antibodies but greater than standard risk of rejection.
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2020, Journal of Cardiothoracic and Vascular AnesthesiaLung Transplant Pathology: An Overview on Current Entities and Procedures
2020, Surgical Pathology ClinicsCitation Excerpt :In these patients, antibodies directed against epithelial cells, referred to as non-HLA DSA or tissue self-antigens (SAGs), such as K-alpha 1 tubulin (Kα1T) and collagen V (Col-V), are being discussed as possible triggers for AMR and subsequent development of CLAD.35–37 Furthermore, DSAs are also thought to play a role not only in AMR but also in hyperacute rejection.38–45 Graft injury by pathologic activation of the recipient’s immune system via DSA can either occur through activation of the complement system (classic pathway) or through complement-independent attraction and activation of inflammatory cells, such as macrophages, natural killer cells, and neutrophils via the FC-receptor subunit of immunoglobulins.