Influence of panel-reactive antibodies on posttransplant outcomes in lung transplant recipients

Background. Panel-reactive antibody (PRA) is used to estimate the degree of humoral sensitization in the recipient before transplantation. Although pr etransplant sensitization is associated with increased complications in oth er solid organ transplant recipients, less is known about the outcome of se nsitized lung transplant recipients. Therefore, we sought to determine the impact of elevated pretransplant PRA on clinical outcomes after lung transp lantation. Methods. The records of the first 200 lung transplant operations performed at Duke University Medical Center were reviewed. The outcomes of sensitized patients, PRA greater than 10% before transplantation (n = 18), were compa red with the outcomes of nonsensitized patients. Results. Sensitized patients experienced a significantly greater number of median ventilator days posttransplant (9 +/- 8) as compared with nonsensiti zed recipients (1 +/- 11; p = 0.0008). There were no significant difference s between the number of episodes of acute rejection; however, there was a s ignificantly increased incidence of bronchiolitis obliterans syndrome occur ring in untreated sensitized recipients (56%) versus nonsensitized (23%; p = 0.044). In addition, there was a trend towards decreased survival in the sensitized recipients, with a 2-year survival of 58% in sensitized recipien ts as compared with 73% in the nonsensitized patients (p = 0.31). Conclusions. Sensitized lung transplant recipients experience more acute an d chronic complications after transplantation. These patients probably warr ant alternative management strategies. (C) 2000 by The Society of Thoracic Surgeons.