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Updated: Mar 6, 2026
Trans-vivo Delayed Type Hypersensitivity Assay for Antigen Specific Regulation
Published on: May 2, 2013
Calculated panel-reactive antibody predicts outcomes on the heart transplant waiting list
Evan P Kransdorf1, Michelle M Kittleson1, Jignesh K Patel1
1Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Insights
Highly sensitized heart transplant candidates face increased risks on the waiting list. Higher calculated panel-reactive antibody (CPRA) levels correlate with decreased transplant rates and higher mortality, necessitating optimized antigen selection strategies.
Area of Science:
- Cardiology
- Transplantation Immunology
- Organ Transplantation
Background:
- Sensitized patients experience longer heart transplant waiting times and higher mortality.
- The role of calculated panel-reactive antibody (CPRA) in heart transplant outcomes is not well-defined.
- CPRA is utilized for kidney transplant allocation priority in the US.
Purpose of the Study:
- To investigate the association between CPRA and outcomes for heart transplant candidates.
- To determine if CPRA influences waiting list survival and transplant rates.
Main Methods:
- Analysis of 3,855 adult heart transplant candidates listed between 2006-2013 from UNOS data.
- Categorization of candidates into 5 groups based on increasing CPRA levels.
- Utilized competing risks and sub-hazard regression for outcome assessment.
Main Results:
- Decreased transplant rates and increased waiting list removal/mortality with higher CPRA.
- Candidates with CPRA >80% had significantly lower transplant incidence (HR 0.37).
- Candidates with CPRA >80% faced substantially higher risk of removal or death (HR 2.18) compared to CPRA ≤10%.
Conclusions:
- Sensitized heart transplant candidates face significant adverse outcomes on the waiting list.
- Minimizing CPRA through specific human leukocyte antigen (HLA) selection is recommended.
- Further research is needed to establish optimal clinical management for high-CPRA candidates.
Background:
Sensitized heart transplant candidates spend more time and have higher mortality on the waiting list. Although the calculated panel-reactive antibody (CPRA) value is used to assign allocation priority to kidney transplant candidates in the United States, the relationship between CPRA and outcomes on the heart transplant waiting list is unknown.
Methods:
A data set of patients listed for heart transplant with unacceptable human leukocyte antigens (HLA) entered was obtained from the United Network for Organ Sharing. The study cohort was composed of 3,855 adult candidates listed for heart transplant between 2006 and 2013 with active waiting time. The cohort was divided into 5 groups by increasing CPRA. Outcomes were assessed using competing risks and sub-hazard regression analyses.
Results:
In each group of successively higher CPRA, the percentage of candidates who received a transplant decreased, whereas the percentage of those who were still waiting for a transplant increased, as did the percentage of those removed from the waiting list or had died. The group of candidates with a CPRA >80% displayed a markedly decreased incidence of transplantation (hazard ratio 0.37) and an increased risk of removal from the waiting list or death (hazard ratio 2.18) as compared to those with CPRA of ≤10%.
Conclusions:
Sensitized heart transplant candidates are at high risk of adverse outcomes on the heart transplant waiting list. Clinicians should strive to minimize the CPRA by maximizing specificity in the selection of HLA antigens to exclude. The optimal clinical approach for candidates with high CPRA requires further study.
