Reducing Morbidity in High Panel Reactive Antibody Heart Transplant Recipients Through Human Leukocyte Antigen Matching

Abstract

<h3>Purpose</h3> A high PRA prior to heart transplantation places recipients at risk for rejection and mortality. The purpose of this study was to assess the impact donor-recipient HLA matching has on post-transplant survival and morbidity. <h3>Methods</h3> A retrospective review of heart transplant recipients in the UNOS database was performed from 2000-2021. Patients were stratified by normal (<25%) and high (≥25%) PRA reactivity. Recipients HLA matched to their donors at ≥ 3 alleles in the high PRA subgroup were identified. Primary outcome was Kaplan-Meier survival estimates at 1, 3 and 5 years post-transplant. Multivariable regression was also performed on high PRA-HLA matched recipients to determine if matching reduced the odds of rejection or infection. <h3>Results</h3> A high PRA was identified in 4,214 heart transplant recipients of which 678 (16%) were HLA matched (Table 1a). Survival estimates were significantly different between normal and high PRA recipients at all primary time points. High PRA-HLA matched patients did not have a significantly different survival than high PRA-HLA mismatched recipients at any time point (Figure 1). On multivariable analysis (Table 1b), HLA matching significantly reduced the odds of graft rejection (OR 0.62) and infection (OR 0.73) <h3>Conclusion</h3> A high PRA places recipients at an increased risk for post-transplant mortality. HLA matching does not improve survival but does significantly reduce the odds of rejection and infection. HLA matching donors to high PRA recipients should be considered to reduce future morbidity, lost time hospitalized and financial burden for these patients.