Influence of panel-reactive antibody and lymphocytotoxic crossmatch on survival after heart transplantation
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J Lavee1, R L Kormos, R J Duquesnoy
1Department of Surgery, Presbyterian-University Hospital, Pittsburgh, Pa.
Insights
High panel-reactive antibody (PRA) levels significantly increase heart transplant rejection risk. A negative donor-specific lymphocytotoxic crossmatch (LXM) does not mitigate this risk in patients with elevated PRA.
Area of Science:
- Immunology
- Cardiology
- Transplantation Science
Background:
- Panel-reactive antibody (PRA) levels and donor-specific lymphocytotoxic crossmatch (LXM) are critical factors in organ transplantation.
- Assessing their impact on heart transplant outcomes is essential for improving patient survival.
Purpose of the Study:
- To investigate the relationship between panel-reactive antibody (PRA) levels and donor-specific lymphocytotoxic crossmatch (LXM) results.
- To determine their impact on hyperacute, acute, and chronic rejection incidence and death after heart transplantation.
Main Methods:
- Retrospective review of 463 heart transplant cases.
- Analysis of panel-reactive antibody (PRA) levels and donor-specific lymphocytotoxic crossmatch (LXM) results.
- Correlation of PRA and LXM with rejection-related death and graft atherosclerosis over five years.
Main Results:
- Five-year freedom from rejection-related death decreased significantly with increasing PRA levels (85% for 0-10% PRA, 68% for 11-25% PRA, 57% for >25% PRA).
- Elevated PRA correlated with longer acute rejection episodes in the first three months post-transplant.
- No significant difference in five-year freedom from rejection-related death was observed between negative, low-positive, and high-positive LXM groups.
- A negative LXM did not reduce rejection risk in any PRA subgroup.
Conclusions:
- Panel-reactive antibody (PRA) level is a significant risk factor for rejection-related events in heart transplantation.
- A negative donor-specific lymphocytotoxic crossmatch (LXM) does not eliminate the increased risk of death from acute or chronic rejection in patients with elevated PRA.
- PRA level is a more critical predictor of post-transplant rejection outcomes than LXM status.
Abstract:
Review of 463 heart transplants was undertaken to examine the relationship between level of panel-reactive antibody (PRA) and a standard donor-specific lymphocytotoxic crossmatch (LXM) on the incidence of death from hyperacute, acute, and chronic rejection. Death from chronic rejection was defined as being caused by graft atherosclerosis. Hyperacute rejection was diagnosed in 18 allografts, and only two recipients had PRA greater than 10% and another two a positive LXM. Five-year actuarial freedom from death caused by all forms of rejection correlated with PRA values as follows: PRA 0% to 10% (415 patients), 85%; PRA 11% to 25% (29 patients), 68%; PRA greater than 25% (19 patients), 57% (p less than 0.005). Additionally, there was a positive linear relationship between PRA and duration of acute rejection episodes in the first 3 months after transplantation. A positive retrospective donor-specific LXM was present in 42 of 401 patients; most of them (32 patients) were low positive (10% to 50% cell death), and none could be correlated with antibody specificity toward donor HLA antigens. Five-year actuarial freedom from death caused by rejection was 83% in those with a negative LXM, 74% in those with low-positive, and 79% in those with high-positive LXM (p = NS). Negative LXM result did not reduce the risk of death caused by rejection in any of the PRA subgroups. While PRA greater than 10% is a risk factor for rejection-related events, a negative LXM in patients with an elevated PRA does not reduce the risk of death resulting from acute or chronic rejection.