Role of panel-reactive antibody cross-reactivity in predicting survival after orthotopic heart transplantation

To test the hypothesis that elevated preformed circulating antibody levels, as measured by panel-reactive antibody levels, predict survival after orthotopic heart transplantation, we analyzed 120 consecutive patients undergoing heart transplantation at the Brigham and Women's Hospital in a retrospective, chart-review format. Prospective, donor-specific lymphocyte crossmatches were performed in all patients with a panel-reactive antibody level of 10% or greater. Both the peak pretransplantation panel-reactive antibody level and the panel-reactive antibody level obtained on the day of transplantation were analyzed with respect to the end points of the number of acute rejection episodes, presence of coronary artery disease, and overall survival after transplantation. Patients with a panel-reactive antibody level on the day of transplantation of 25% or greater, despite a negative prospective donor-specific lymphocyte crossmatch, demonstrated a trend toward reduced actuarial long-term survival compared with patients with panel-reactive antibody values less than 25% (p < 0.05). Panel-reactive antibody levels were not predictive of the number of acute rejection episodes, early (< 60 days) versus late (> or = 60 days) death, or the development of graft coronary artery disease. No episodes of hyperacute rejection were observed, even in six patients with a positive retrospective donor-specific lymphocyte crossmatch. In conclusion, an elevated panel-reactive antibody value of 25% or greater at the time of heart transplantation may be a risk factor for decreased long-term survival. A trend toward an increased risk of death caused by rejection was also observed.(ABSTRACT TRUNCATED AT 250 WORDS)