이달의 증례
| Impacts of Pre-transplant Panel-Reactive Antibody on Post-transplantation Outcomes: A Study of Nationwide Heart Transplant Registry Data | |||
|---|---|---|---|
| 년도 | 2024년 6월 | ||
| 카테고리 | 이달의 kcj Hot Article | ||
| 저자 | Darae Kim, MD, PhD,1 Jin-Oh Choi, MD, PhD,,1 Yang Hyun Cho, MD, PhD,2 Kiick Sung, MD, PhD,2 Jaewon Oh, MD,3 Hyun Jai Cho, MD, PhD,4 Sung-Ho Jung, MD,5 Hae-Young Lee, MD, PhD,4 Jin Joo Park, MD, PhD,6 Dong-Ju Choi, MD, PhD,6 Seok-Min Kang, MD, PhD,3 Myoung Soo Kim, MD, PhD,7 and Jae-Joong Kim, MD, PhD,8 | ||
| 소속 | 1Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. 4Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. 5Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 6Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. 7Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. 8Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. |
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| 첨부파일 1 | KCJ-23-300 GAv2.jpg | ||
- 관리자
- 등록일 : 2024.07.02
- Hit 205
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.
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