Impact of Donor-Recipient HLA Matching on Survival and Morbidity in High PRA Lung Transplant Recipients
Presented During:
Sunday, May 4, 2025: 9:00AM - 4:00PM
Seattle Convention Center | Summit
Posted Room Name:
Poster Area, Exhibit Hall
Abstract No:
P0173
Submission Type:
Abstract Submission
Authors:
David Herbst (1), Clayton Rust (2), Christopher He (3), Lucy Avant (3), Ailin Tang (3), Rachel Holstein (3), Supreet Randhawa (3), Reshma Kodimerla (3), Helen Abadiotakis (3), Ahanna Onyenso (3), James Sherrer (3), Stephanie Tom (3), Catherine McGeoch (3), Ikenna Obi (3), James Keiler (3), Tyson McLeish (4), Muath Bishawi (3), Mani Daneshmand (3), Joshua Chan (5)
Institutions:
(1) Emory Univ School of Medicine, Atlanta, GA, (2) Carlyle Fraser Heart Center, Emory University Cardiothoracic Research Laboratory, Atlanta, GA, (3) Emory University School of Medicine, Atlanta, GA, (4) N/A, Milwaukee, WI, (5) N/A, Atlanta, GA
Submitting Author:
David Herbst
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Emory Univ School of Medicine
Emory Univ School of Medicine
Co-Author(s):
Clayton Rust
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Carlyle Fraser Heart Center, Emory University Cardiothoracic Research Laboratory
Carlyle Fraser Heart Center, Emory University Cardiothoracic Research Laboratory
Christopher He
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Emory University School of Medicine
Emory University School of Medicine
Lucy Avant
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Emory University School of Medicine
Emory University School of Medicine
Ailin Tang
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Emory University School of Medicine
Emory University School of Medicine
Rachel Holstein
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Emory University School of Medicine
Emory University School of Medicine
Supreet Randhawa
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Emory University School of Medicine
Emory University School of Medicine
Reshma Kodimerla
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Emory University School of Medicine
Emory University School of Medicine
Helen Abadiotakis
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Emory University School of Medicine
Emory University School of Medicine
Ahanna Onyenso
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Emory University School of Medicine
Emory University School of Medicine
James Sherrer
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Emory University School of Medicine
Emory University School of Medicine
Stephanie Tom
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Emory University School of Medicine
Emory University School of Medicine
Catherine McGeoch
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Emory University School of Medicine
Emory University School of Medicine
Ikenna Obi
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Emory University School of Medicine
Emory University School of Medicine
James Keiler
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Emory University School of Medicine
Emory University School of Medicine
Tyson McLeish
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N/A
Muath Bishawi
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Emory University School of Medicine
Emory University School of Medicine
*Mani Daneshmand
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Emory University School of Medicine
Emory University School of Medicine
Joshua Chan
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Presenting Author:
David Herbst
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Emory Univ School of Medicine
Emory Univ School of Medicine
Abstract:
Objective
A high PRA prior to lung transplantation places recipients at risk for rejection and mortality. However, the effect of donor-recipient immunologic characteristics on these outcomes is less clear. This study aimed to assess the impact of donor-recipient HLA matching on post-transplant survival and morbidity using a national transplant database.
Methods
A retrospective review of lung transplant recipients from the United Network for Organ Sharing (UNOS) database between 2000 and 2023 was conducted. Patients were stratified by PRA levels: normal (<49%) and high (≥50%). Recipients with high PRA who were HLA matched to their donors at ≥ 3 alleles were identified. The primary outcome was 1-year post-transplant survival, assessed using Kaplan-Meier estimates. Survival rates were also compared within the high PRA subgroup based on HLA matching status. Multivariable regression was performed on high PRA-HLA matched recipients to evaluate whether HLA matching reduced the odds of rejection or infection.
Results
Out of 31,303 lung transplant recipients in the UNOS database, 1,930 (6%) had high PRA. Among these, 343 (18%) were HLA matched to their donors. One-year survival was significantly lower in high PRA recipients. However, within the high PRA subgroup, HLA matching significantly improved one-year survival (Figure). Multivariable regression analysis revealed that HLA matching significantly reduced the odds of graft rejection (OR 0.73, 95% CI 0.55-0.97) and trended toward reducing hospitalizations for infections (OR 0.79, 95% CI 0.62-1.02). Subgroup analysis revealed that patients transplanted at high-volume centers had significantly lower odds of hospitalization for infection (OR 0.71, 95% CI 0.59-0.87).
Conclusion
As previously demonstrated, a high PRA increases the risk of post-transplant mortality. However, modifying recipient-donor immunologic compatibility by HLA matching improves 1-year survival and significantly reduces the risk of rejection in high PRA recipients. Consideration of transplanting high PRA patients in high volume centers may reduce future morbidity, hospitalization time, and financial burden. Future studies will analyze the interaction between immunosuppression regimen and HLA matching in high PRA lung transplant recipients.
A high PRA prior to lung transplantation places recipients at risk for rejection and mortality. However, the effect of donor-recipient immunologic characteristics on these outcomes is less clear. This study aimed to assess the impact of donor-recipient HLA matching on post-transplant survival and morbidity using a national transplant database.
Methods
A retrospective review of lung transplant recipients from the United Network for Organ Sharing (UNOS) database between 2000 and 2023 was conducted. Patients were stratified by PRA levels: normal (<49%) and high (≥50%). Recipients with high PRA who were HLA matched to their donors at ≥ 3 alleles were identified. The primary outcome was 1-year post-transplant survival, assessed using Kaplan-Meier estimates. Survival rates were also compared within the high PRA subgroup based on HLA matching status. Multivariable regression was performed on high PRA-HLA matched recipients to evaluate whether HLA matching reduced the odds of rejection or infection.
Results
Out of 31,303 lung transplant recipients in the UNOS database, 1,930 (6%) had high PRA. Among these, 343 (18%) were HLA matched to their donors. One-year survival was significantly lower in high PRA recipients. However, within the high PRA subgroup, HLA matching significantly improved one-year survival (Figure). Multivariable regression analysis revealed that HLA matching significantly reduced the odds of graft rejection (OR 0.73, 95% CI 0.55-0.97) and trended toward reducing hospitalizations for infections (OR 0.79, 95% CI 0.62-1.02). Subgroup analysis revealed that patients transplanted at high-volume centers had significantly lower odds of hospitalization for infection (OR 0.71, 95% CI 0.59-0.87).
Conclusion
As previously demonstrated, a high PRA increases the risk of post-transplant mortality. However, modifying recipient-donor immunologic compatibility by HLA matching improves 1-year survival and significantly reduces the risk of rejection in high PRA recipients. Consideration of transplanting high PRA patients in high volume centers may reduce future morbidity, hospitalization time, and financial burden. Future studies will analyze the interaction between immunosuppression regimen and HLA matching in high PRA lung transplant recipients.
THORACIC:
End Stage Lung Disease and Lung Transplantation
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