Korean J Transplant.  2023 Nov;37(Suppl 1):S273. 10.4285/ATW2023.F-8867.

Impacts of pretransplant panel-reactive antibody on posttransplantation outcomes: a study of nationwide heart transplant registry data

• Kim D
• Choi JO
• Cho YH
• Jung SH
• Lee HY
• Choi DJ
• Kang SM
• Kim JJ

• KMID: 2551902
• DOI: http://doi.org/10.4285/ATW2023.F-8867

Abstract

Background
The number of sensitized heart failure (HF) patients on waiting lists for heart transplantation (HTx) is increasing. We investigated the prevalence and clinical impact of calculated panel-reactive antibody (cPRA) in patients undergoing HTx using the Korean Organ Transplantation Registry (KOTRY), a nation-wide multicenter database.
Methods
We retrospectively reviewed 813 patients who underwent HTx between 2014 and 2021. Patients were grouped according to peak PRA level as group A, patients with cPRA <10% (n=492); group B, patients with cPRA ≥10% & <50% (n=160); group C, patients with cPRA ≥50% (n=161). Post-HTx outcomes were freedom from antibody-mediated rejection (AMR), any treated rejection, acute cellular rejection, coronary allograft vasculopathy, and all-cause mortality.
Results
The median follow up duration was 44 months (range,19–72). Female sex, retransplantation, and pre-HTx renal replacement therapy were independently associated with increased risk of sensitization (cPRA ≥50%). Group C patients were more likely to have longer hospital stay and to use anti-thymocyte globulin as an induction agent compared to groups B and C. Significantly more patients in group C had positive flow-cytometric crossmatch, and had higher incidence of preformed donor-specific antibody compared to groups A and B. During follow-up, group C had significantly lower rates of freedom from AMR, but the overall survival rate was comparable with those of groups A and B.
Conclusions
Patients with cPRA ≥50% had significantly higher incidence of preformed DSA and lower freedom from AMR but post-HTx survival rates were similar to those with cPRA <50%.