Calculated panel-reactive antibody predicts outcomes on the heart transplant waiting list

Kransdorf, E.; Kittleson, M.; Patel, Jignesh; Pando, Marcelo J.; Steidley, D. Eric; Kobashigawa, Jon A.

doi:10.1016/j.healun.2017.02.015

Cited by 73 publications

(63 citation statements)

References 34 publications

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“…5 Thus, this is a major risk factor for patients who would benefit from heart transplantation and its modification is key for improving outcomes. A greater cPRA is associated with a lower percentage of candidates receiving a transplant as well as an increased risk of removal from the waiting list or death on the list.…”

Section: De Tec Ti On Of Antibod Ie Smentioning

confidence: 99%

“…1 Importantly, the presence of sensitization is associated with a greater long-term mortality after transplant. 5 The incidence of this problem is growing with a greater number of heart transplant recipients having evidence of sensitization over the past decade. 3,4 As a consequence, mortality on the waitlist is also increased.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 As a consequence, mortality on the waitlist is also increased. 5 The incidence of this problem is growing with a greater number of heart transplant recipients having evidence of sensitization over the past decade. 6…”

Section: Introductionmentioning

confidence: 99%

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Desensitization in heart transplant recipients: Who, when, and how

Shah

Patel

2019

Clinical Transplantation

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The number of heart transplant candidates who have pre-formed antibodies against human leukocyte antigens (HLAs) is increasing over time. The purpose of this review is to discuss the process of antibody desensitization for heart transplant candidates. Specifically, we review the current status of antibody detection including identification, strength, and potential pathogenicity. We discuss which patients and when should they undergo desensitization therapies during heart transplant evaluation. Specific therapies including mechanical removal of antibodies, intravenous immunoglobulins, and novel immunosuppressive agents targeting antibody production will be discussed. Finally, future research strategies to develop novel desensitization therapies for heart transplant candidates will be reviewed. K E Y W O R D Sdesensitization, heart disease, sensitization

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Section: De Tec Ti On Of Antibod Ie Smentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Desensitization in heart transplant recipients: Who, when, and how

Shah

Patel

2019

Clinical Transplantation

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“…A previous study from the PHTS using PRA > 20% (determined by CDC method) and a positive cross‐match has been shown to decrease graft survival at 1 year post‐transplant; interestingly, there is no difference in rejection outcomes based on sensitization status . Also, two studies from the UNOS scientific registry database have shown that effect of sensitization (determined by flow cytometry) was more strikingly evident on post‐transplant outcomes when the PRA was analyzed in 20% increments …”

Section: Introductionmentioning

confidence: 95%

“…3 Also, two studies from the UNOS scientific registry database have shown that effect of sensitization (determined by flow cytometry) was more strikingly evident on post-transplant outcomes when the PRA was analyzed in 20% increments. 10,11 The flow PRA is defined as the detection of Class I and Class II HLA antibodies by SPA using Luminex or flow cytometry and allows semi-quantitative detection of HLA antibodies with a high level of sensitivity and specificity. 12 However, the flow PRA does not distinguish between complement-and non-complement-fixing HLA antibodies and the functional significance of a high flow PRA remains unclear.…”

Section: Introductionmentioning

confidence: 99%

The impact of flow PRA on outcome in pediatric heart recipients in modern era: An analysis of the Pediatric Heart Transplant Study database

Das

Pruitt

Molina

et al. 2017

Pediatric Transplantation

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Data from patients in the Pediatric Heart Transplant Study (PHTS) registry transplanted between 2010 and 2014 were analyzed to determine the association between HLA antibody (PRA) determined by SPA using Luminex or flow cytometry with a positive retrospective cross-match and the post-transplant outcomes of acute rejection and graft survival. A total of 1459 of 1596 (91%) recipients had a PRA reported pretransplant; 26% had a PRA > 20%. Patients with a PRA > 20% were more likely to have CHD, prior cardiac surgery, ECMO support at listing, and waited longer for transplantation than patients with a PRA <20%. Patients with higher PRA% determined by SPA were predictive of a positive retrospective cross-match determined by flow cytometric method (P < .001). A PRA > 50% determined by SPA was independently associated with worse overall graft survival after first month of transplant in both unadjusted and adjusted for all other risk factors. In this large multicenter series of pediatric heart transplant recipients, an elevated PRA determined by SPA remains a significant risk factor in the modern era.

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Optimizing Beneficence and Justice in Heart Transplant Allocation

Kittleson

2024

JAMA

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Calculated panel-reactive antibody predicts outcomes on the heart transplant waiting list

Cited by 73 publications

References 34 publications

Desensitization in heart transplant recipients: Who, when, and how

Desensitization in heart transplant recipients: Who, when, and how

The impact of flow PRA on outcome in pediatric heart recipients in modern era: An analysis of the Pediatric Heart Transplant Study database

Optimizing Beneficence and Justice in Heart Transplant Allocation

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