The Impact of the Calculated Panel Reactive Antibody Value on Wait List Outcomes for Lung Transplant Candidates

Abstract

Purpose We conducted a retrospective cohort study using United Network of Organ Sharing (UNOS) data to determine the impact of the calculated panel reactive antibody (cPRA) value on wait list outcomes for lung transplant candidates. Methods A dataset of candidates listed for lung transplant from 2005-2017 was obtained from UNOS. We divided the candidates into groups based on their cPRA value at the time of wait list activation (0-25%, 25.1-50%, 50.1-75%, 75.1-100%) and compared each group to the lowest quartile (or minimally sensitized, MS) group using a competing risk regression model. The primary outcome was lung transplant. The secondary outcome was death/delisting for clinical deterioration. Results Figure 1 shows the frequency of wait list outcomes by cPRA value at the time of wait list activation. Candidates with a cPRA value of 25.1-50% at the time of wait list activation did not have a significantly different likelihood of lung transplant or death/delisting for clinical deterioration than the MS group. Candidates with a cPRA value of 50.1-75% were 25% less likely to undergo lung transplant and were 44% more likely to die/be delisted for clinical deterioration than the MS group. Candidates with a cPRA value of 75.1-100% were 52% less likely to undergo lung transplant and were 92% more likely to die/be delisted for clinical deterioration than the MS group. Figure 2 shows the cumulative incidence of lung transplant (A) and death/delisting for clinical deterioration (B) by cPRA value. Conclusion CPRA values of greater than 50% are associated with a significantly lower rate of lung transplant and higher wait list mortality.