INFLUENCE OF PANEL-REACTIVE ANTIBODY ON SURVIVAL AND REJECTION AFTER LUNG TRANSPLANTATION

Background: Panel-reactive antibody (PRA) is commonly used before thor acic organ transplantation to estimate a potential recipient's degree of humoral sensitization. Methods: To assess the influence of an eleva ted PRA on survival and the incidence of rejection in pulmonary transp lantation, the records of 247 patients that underwent single or double lung transplantation were reviewed. Results: Twenty-one of 247 patien ts (8.5%) had PRA values greater than 10%. Survival of this population was not significantly different from that of patients with low PRA le vels: 74% (low PRA) vs 65% (elevated PRA) at 1 year and 58% in both gr oups at 3 years. The acute rejection rates (episodes/first 100 days) f or the elevated and low PRA groups were 2.1 and 1.9, respectively (p = NS). Obliterative bronchiolitis developed in 38.9% of the high and 31 .2% of the low PRA groups (p = NS). Six of 247 patients had a retrospe ctive positive lymphocytotoxic cross-match result; three had PRA value s greater than 10%. Patients with a positive cross-match result experi enced similar survival and incidence of rejection as the remainder of the population. among 957 patients evaluated for lung transplantation, 16 (1.7%) had a PRA (with dithiothreitol) greater than 15%. All had a history of pregnancy, blood transfusion, connective tissue disease, o r previous transplantation. Conclusions: Humoral sensitization is unco mmon in the lung transplantation population. A modestly elevated PRA d oes not predict survival or the development of acute rejection or bron chiolitis obliterans. PRA testing before lung transplantation should b e reserved for those patients with specific risk factors for humoral s ensitization.