Skip to main content
Journal cover image

Increased Calculated Panel Reactive Antigen Is Associated With Increased Waitlist Time and Mortality in Lung Transplantation.

Publication ,  Journal Article
Barac, YD; Mulvihill, MS; Jawitz, O; Klapper, J; Haney, J; Daneshmand, M; Nasir, B; Chen, D; Milano, CA; Hartwig, MG
Published in: Ann Thorac Surg
August 2020

BACKGROUND: Sensitized candidates with unacceptable antigens are a group that demands special attention in organ transplantation. Calculated panel reactive antigen (cPRA) is not used to modify allocation priorities in lung transplantation. The impact of cPRA on waiting list time and mortality is unknown. METHODS: We performed a retrospective review of candidates for lung transplantation listed from May 2005 to 2018. Data from the Organ Procurement and Transplantation Network/United Network for Organ Sharing STAR (Standard Analysis and Research) dataset was paired with additional unacceptable human leukocyte antigen (UA-HLA) data, which were used to calculate the listing cPRA. Candidates were stratified based on the lack of UA-HLAs or cPRA level for candidates with unacceptable antigens reported. Unadjusted competing risks and adjusted subdistribution hazard models were fit. RESULTS: A total of 29,085 candidates met inclusion criteria for analysis. Of these, 23,562 (81%) with no UA-HLAs, 3472 (11.9%) with a cPRA less than 50, and 2051 with a cPRA greater than or equal to 50 (7.1%). On adjusted analysis, a cPRA greater than or equal to 50 was independently associated with increased waitlist mortality at 1 year (hazard ratio, 1.71; 95% confidence interval, 1.55-1.88; P < .001) and decreased rate of transplantation (71.9% vs 69.5% vs 44.4%; P < .001). Furthermore, patients with a cPRA greater than or equal to 50 had a longer waitlist time compared with a cPRA less than 50 and no UA-HLA candidates (mean 293.69 days vs 162.38 days and 143.26 days, respectively; P < .001). However, once transplanted, posttransplant survival among the cohorts was similar. CONCLUSIONS: Further evaluation of organ allocation with consideration of a candidate's cPRA may be warranted in order to optimize equity in access to transplants.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

August 2020

Volume

110

Issue

2

Start / End Page

414 / 423

Location

Netherlands

Related Subject Headings

  • Waiting Lists
  • Transplantation Immunology
  • Tissue and Organ Procurement
  • Time Factors
  • Retrospective Studies
  • Respiratory System
  • Patient Selection
  • Middle Aged
  • Male
  • Lung Transplantation
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Barac, Y. D., Mulvihill, M. S., Jawitz, O., Klapper, J., Haney, J., Daneshmand, M., … Hartwig, M. G. (2020). Increased Calculated Panel Reactive Antigen Is Associated With Increased Waitlist Time and Mortality in Lung Transplantation. Ann Thorac Surg, 110(2), 414–423. https://doi.org/10.1016/j.athoracsur.2020.02.061
Barac, Yaron D., Mike S. Mulvihill, Oliver Jawitz, Jacob Klapper, John Haney, Mani Daneshmand, Basil Nasir, Dongfeng Chen, Carmelo A. Milano, and Matthew G. Hartwig. “Increased Calculated Panel Reactive Antigen Is Associated With Increased Waitlist Time and Mortality in Lung Transplantation.Ann Thorac Surg 110, no. 2 (August 2020): 414–23. https://doi.org/10.1016/j.athoracsur.2020.02.061.
Barac YD, Mulvihill MS, Jawitz O, Klapper J, Haney J, Daneshmand M, et al. Increased Calculated Panel Reactive Antigen Is Associated With Increased Waitlist Time and Mortality in Lung Transplantation. Ann Thorac Surg. 2020 Aug;110(2):414–23.
Barac, Yaron D., et al. “Increased Calculated Panel Reactive Antigen Is Associated With Increased Waitlist Time and Mortality in Lung Transplantation.Ann Thorac Surg, vol. 110, no. 2, Aug. 2020, pp. 414–23. Pubmed, doi:10.1016/j.athoracsur.2020.02.061.
Barac YD, Mulvihill MS, Jawitz O, Klapper J, Haney J, Daneshmand M, Nasir B, Chen D, Milano CA, Hartwig MG. Increased Calculated Panel Reactive Antigen Is Associated With Increased Waitlist Time and Mortality in Lung Transplantation. Ann Thorac Surg. 2020 Aug;110(2):414–423.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

August 2020

Volume

110

Issue

2

Start / End Page

414 / 423

Location

Netherlands

Related Subject Headings

  • Waiting Lists
  • Transplantation Immunology
  • Tissue and Organ Procurement
  • Time Factors
  • Retrospective Studies
  • Respiratory System
  • Patient Selection
  • Middle Aged
  • Male
  • Lung Transplantation