ROLE OF PANEL-REACTIVE ANTIBODY CROSS-REACTIVITY IN PREDICTING SURVIVAL AFTER ORTHOTOPIC HEART-TRANSPLANTATION

To test the hypothesis that elevated preformed circulating antibody le vels, as measured by panel-reactive antibody levels, predict survival after orthotopic heart transplantation, we analyzed 120 consecutive pa tients undergoing heart transplantation at the Brigham and Women's Hos pital in a retrospective, chart-review format. Prospective; donor-spec ific lymphocyte crossmatches were performed in all patients with a pan el-reactive antibody level of 10% or greater. Both the peak pretranspl antation panel-reactive antibody level and the panel-reactive antibody level obtained on the day of transplantation were analyzed with respe ct to the end points of the number of acute rejection episodes, presen ce of coronary artery disease, and overall survival after transplantat ion. Patients with a panel-reactive antibody level on the day of trans plantation of 25% or greater, despite a negative prospective donor-spe cific lymphocyte crossmatch, demonstrated a trend toward reduced actua rial long-term survival compared with patients with panel-reactive ant ibody values less than 25% (p < 0.05). Panel-reactive antibody levels were not predictive of the number of acute rejection episodes, early ( < 60 days) versus late (greater-than-or-equal-to 60 days) death, or th e development of graft coronary artery disease. No episodes of hyperac ute rejection were observed, even in six patients with a positive retr ospective donor-specific lymphocyte crossmatch. In conclusion, an elev ated panel-reactive antibody value of 25% or greater at the time of he art transplantation may be a risk factor for decreased long-term survi val. A trend toward an increased risk of death caused by rejection was also observed. Finally, the absence of any episodes of hyperacute rej ection in patients with positive retrospective lymphocytotoxic crossma tches again raises the need to reevaluate the utility of prospective d onor-specific lymphocyte crossmatches to prevent this complication.