P173. Impact of Donor-Recipient HLA Matching on Survival and Morbidity in High PRA Lung Transplant Recipients
Presented During: Thoracic Poster Session II
Emory Univ School of Medicine
Atlanta, GA
United States - Contact Me
Dr. Alan Herbst is a first year traditional CT fellow at Emory University. He completed his general surgery residency at The University of Pennsylvania. He has an interest in adult cardiac surgery.
Sunday, May 4, 2025: 9:00 AM - 4:00 PM
Seattle Convention Center | Summit
Room: Poster Area, Exhibit Hall
Description
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.
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
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.
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