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Pre-transplant Panel Reactive Antibody and Survival in Adult Cystic Fibrosis Patients After Lung Transplantation

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Abstract

Background

Survival implications of pre-transplant antibodies to human leukocyte antigens prior to lung transplantation (LTx) in adult cystic fibrosis (CF) patients are unknown.

Methods

Data from the United Network for Organ Sharing Registry (1987–2013) were used to compare survival differences in adult CF patients with pre-transplant class I and II panel reactive antibody (PRA) levels ≤10 versus >10 %.

Results

Of 3149 CF LTx recipients, 1526 and 1399 were included in univariate survival analyses of class I and II PRA, respectively, while 1106 and 1001 were included in multivariate Cox analyses for class I and class II, respectively. Kaplan–Meier survival functions failed to demonstrate significant differences in survival with PRA >10 % for class I (Log-rank test: χ 2 (df = 1): 1.11, p = 0.293) or class II (Log-rank test: χ 2 (df = 1): 0.99, p = 0.320). Adjusting for covariates, multivariate Cox models demonstrated that class II PRA >10 % was associated with a significant increase in mortality hazard (HR 1.918; 95 % CI 1.128, 3.261; p = 0.016), whereas class I PRA >10 % was uncorrelated with this outcome.

Conclusions

Pre-transplant PRA class II >10 % in adult CF patients is associated with elevated mortality hazard after LTx.

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Abbreviations

BMI:

Body mass index

CF:

Cystic fibrosis

DSAs:

Donor-specific antibodies

FEV1 :

Forced expiratory volume in one second

FVC:

Forced vital capacity

HLAs:

Human leukocyte antigens

LTx:

Lung transplantation

OPTN:

Organ Procurement and Transplant Network

PRA:

Panel reactive antibody

6MWD:

6-Minute walk distance

UNOS:

United Network for Organ Sharing

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Author contribution

Don Hayes, Jr.: Conception and design, acquisition of data, interpretation of data, drafting of the manuscript. Dmitry Tumin: Statistical analysis, interpretation of data, revision of the manuscript. Joseph D. Tobias: Interpretation of data, revision of the manuscript.

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Authors and Affiliations

  1. Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA

    Don Hayes Jr. & Dmitry Tumin

  2. Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA

    Don Hayes Jr.

  3. Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA

    Joseph D. Tobias

  4. Section of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, OH, USA

    Don Hayes Jr.

  5. Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA

    Dmitry Tumin & Joseph D. Tobias

  6. The Ohio State University, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA

    Don Hayes Jr.

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  1. Don Hayes Jr.
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Correspondence to Don Hayes Jr..

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Hayes, D., Tumin, D. & Tobias, J.D. Pre-transplant Panel Reactive Antibody and Survival in Adult Cystic Fibrosis Patients After Lung Transplantation. Lung 194, 429–435 (2016). https://doi.org/10.1007/s00408-016-9861-8

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  • DOI: https://doi.org/10.1007/s00408-016-9861-8

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