Impacts of Pretransplant Panel-Reactive Antibody on Posttransplantation Outcomes: a Study of Nationwide Heart Transplant Registry Data

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, retransplantation, 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.