Korean Circ J.  2024 Jun;54(6):325-335. 10.4070/kcj.2023.0300.

Impacts of Pre-transplant Panel-Reactive Antibody on Post-transplantation Outcomes: A Study of Nationwide Heart Transplant Registry Data

• Kim D
• Choi JO
• Cho YH
• Sung K
• Oh J
• Cho HJ
• Jung SH
• Lee HY
• Park JJ
• Choi DJ
• Kang SM
• Kim MS
• Kim JJ

• KMID: 2556530
• DOI: http://doi.org/10.4070/kcj.2023.0300

Abstract

Background and Objectives
The number of sensitized heart failure patients on waiting lists for heart transplantation (HTx) is increasing. Using the Korean Organ Transplantation Registry (KOTRY), a nationwide multicenter database, we investigated the prevalence and clinical impact of calculated panel-reactive antibody (cPRA) in patients undergoing HTx.
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), acute cellular rejection, coronary allograft vasculopathy, and all-cause mortality.
Results
The median follow-up duration was 44 (19–72) months. Female sex, retransplantation, and pre-HTx renal replacement therapy were independently associated with an increased risk of sensitization (cPRA ≥50%). Group C patients were more likely to have longer hospital stays and to use anti-thymocyte globulin as an induction agent compared to groups A and B. Significantly more patients in group C had positive flow cytometric crossmatch and had a higher incidence of preformed donor-specific antibody (DSA) compared to groups A and B. During follow-up, group C had a significantly higher rate of AMR, but the overall survival rate was comparable to that of groups A and B. In a subgroup analysis of group C, post-transplant survival was comparable despite higher preformed DSA in a desensitized group compared to the non-desensitized group.
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%. Our findings suggest that sensitized patients can attain comparable post-transplant survival to non-sensitized patients when treated with optimal desensitization treatment and therapeutic intervention.

Keyword

Heart transplantation; Prognosis; Antibodies; Human leukocyte antigen

Figure

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  Figure 1 Post-HTx survival rates (A) and freedom from AMR (B) according to the pre-transplant PRA category.AMR = antibody-mediated rejection; HTx = heart transplantation; PRA = panel-reactive antibodies.

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