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

Autor:	Barac YD; Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: yaronbar@icloud.com., Mulvihill MS; Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina., Jawitz O; Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina., Klapper J; Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina., Haney J; Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina., Daneshmand M; Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina., Nasir B; Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina., Chen D; Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina., Milano CA; Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina., Hartwig MG; Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2020 Aug; Vol. 110 (2), pp. 414-423. Date of Electronic Publication: 2020 Apr 03.
DOI:	10.1016/j.athoracsur.2020.02.061
Abstrakt:	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. (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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