Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Impacts of Pre-transplant Panel-Reactive Antibody on Post-transplantation Outcomes: A Study of Nationwide Heart Transplant Registry Data

  • Darae Kim (Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jin-Oh Choi (Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yang Hyun Cho (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kiick Sung (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jaewon Oh (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Hyun Jai Cho (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Sung-Ho Jung (Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hae-Young Lee (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Jin Joo Park (Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital) ;
  • Dong-Ju Choi (Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital) ;
  • Seok-Min Kang (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Myoung Soo Kim (Department of Surgery, Yonsei University College of Medicine) ;
  • Jae-Joong Kim (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2023.11.10
  • Accepted : 2024.02.26
  • Published : 2024.06.01
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Abstract

Background and Objectives: The number of sensitized heart failure patients on waiting lists for heart transplantation (HTx) is increasing. Using the Korean Organ Transplantation Registry (KOTRY), a nationwide multicenter database, we investigated the prevalence and clinical impact of calculated panel-reactive antibody (cPRA) in patients undergoing HTx. Methods: We retrospectively reviewed 813 patients who underwent HTx between 2014 and 2021. Patients were grouped according to peak PRA level as group A: patients with cPRA ≤10% (n= 492); group B: patients with cPRA >10%, <50% (n=160); group C patients with cPRA ≥50% (n=161). Post-HTx outcomes were freedom from antibody-mediated rejection (AMR), acute cellular rejection, coronary allograft vasculopathy, and all-cause mortality. Results: The median follow-up duration was 44 (19-72) months. Female sex, re-transplantation, and pre-HTx renal replacement therapy were independently associated with an increased risk of sensitization (cPRA ≥50%). Group C patients were more likely to have longer hospital stays and to use anti-thymocyte globulin as an induction agent compared to groups A and B. Significantly more patients in group C had positive flow cytometric crossmatch and had a higher incidence of preformed donor-specific antibody (DSA) compared to groups A and B. During follow-up, group C had a significantly higher rate of AMR, but the overall survival rate was comparable to that of groups A and B. In a subgroup analysis of group C, post-transplant survival was comparable despite higher preformed DSA in a desensitized group compared to the non-desensitized group. Conclusions: Patients with cPRA ≥50% had significantly higher incidence of preformed DSA and lower freedom from AMR, but post-HTx survival rates were similar to those with cPRA <50%. Our findings suggest that sensitized patients can attain comparable post-transplant survival to non-sensitized patients when treated with optimal desensitization treatment and therapeutic intervention.

Keywords

Acknowledgement

This research was supported by the "National Institute of Health" research project (code 2014-ER6301-00, 2014-ER6301-01, 2014-ER6301-02, 2017-ER6301-00, 2017-ER6301-01, 2017-ER6301-02, 2020-ER7201-00, 2020-ER7201-01, 2020-ER7201-02, 2023-ER0805-00).

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