High Calculated Panel Reactive Antigen (cPRA) is Associated with Decreased Rates of Transplantation and Increased Waitlist Mortality in Lung Transplantation: A UNOS/OPTN Registry Analysis

Abstract

Purpose Sensitized candidates with unacceptable antigens are a group that demands special attention in lung transplantation . While calculated panel reactive antigen (cPRA) is used to assign allocation priorities in some solid organ transplants, this is not the case in lung transplantation. The association between cPRA and lung transplant outcomes is unknown, as well as the impact of cPRA on waiting list time and mortality. Methods We performed a retrospective cohort review from May, 2005 to 2018 of the SRTR registry with additional unacceptable antigen (UA) data provided by UNOS, that was used to calculate the pre-transplant cPRA (for candidates that provided UA data), for candidates ≥ 12 years of age waitlisted for first-time isolated lung transplantation. Candidates were stratified based upon lack of unacceptable antigen or cPRA for patients with any unacceptable antigens reported. Unadjusted competing risks and adjusted sub-distribution hazard models were fit. Results 29,008 candidates met inclusion criteria including 23,490 with no cPRA, 3,470 with cPRA Conclusion Sensitized lung transplant candidates experience longer waitlist times, lower rates of transplantation, and higher rates of waitlist mortality. Further evaluation of allocating organs with consideration of candidate cPRA may be warranted in order to optimize equity in access to transplants.