26. INFLUENCE OF PANEL-REACTIVE ANTIBODY ON POSTTRANSPLANT OUTCOMES IN LUNG TRANSPLANT RECIPIENTS
Christine L. Lau, Scott Palmer, Katherine E. Posther, Nancy Reinsmoen, David Howell, Howard T. Massey, Victor F. Tapson, Thomas A. DAmico, R. Duane Davis, Jr.*
Duke University Medical Center
Durham, North Carolina, USA
OBJECTIVE
Panel reactive antibody (PRA) is used to estimate the degree of humoral sensitization in the recipient prior to transplantation. Although pretransplant sensitization is associated with increased complications in other solid organ transplant recipients, less is known about the outcome of sensitized lung transplant recipients. Therefore, we sought to determine the impact of elevated pretransplant PRA on clinical outcomes after lung transplantation.
METHODS
The records of the first 200 lung transplant operations performed at Duke University Medical Center were reviewed. The outcomes of sensitized patients (16/200) (PRA > 10% prior to transplantation) were compared to the outcomes of nonsensitized patients (184/200).
RESULTS
Sensitized patients had a significantly greater number of median ventilator days posttransplant (9
± 8) as compared to nonsensitized recipients (1± 11; P=0.0008). There was no significant differences between the number of episodes of acute rejection; however, there was a significantly increased incidence of bronchiolitis obliterans syndrome occurring in sensitized recipients (65%) vs nonsensitized recipients (23%; P=0.044). In addition, there was a trend towards decreased survival in the sensitized recipients, with two-year survival of 58% in sensitized recipients as compared to 73% in the nonsensitized patients.CONCLUSION
Sensitized lung transplant recipients experience more acute and chronic complications after transplantation. These patients probably warrant alternative management strategies.
