Association between Allosensitization and Waiting List Outcomes among Adult Lung Transplant Candidates in the United States
Association between Allosensitization and Waiting List Outcomes among Adult Lung Transplant Candidates in the United States
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DOI：
10.1513/annalsats.201810-713oc
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发表时间：
2019-07-01
影响因子：
8.3
通讯作者：
Hachem, Ramsey R.
中科院分区：
文献类型：
--
作者：
Tague, Laneshia K.;Witt, Chad A.;Hachem, Ramsey R.
原理：同种异体致敏可能是肺移植的障碍。目前，在肺移植等候名单上分配优先级时，没有考虑到同种异体致敏性。目的：我们旨在研究同种异体致敏性与等候名单结局之间的相关性。方法：我们对2006年1月1日至2016年12月31日期间在我们中心登记进行肺移植的成人进行了回顾性单中心队列研究。我们筛选候选人的人类白细胞抗原抗体上市前，并检查之间的关联allosensitization和等待名单的结果，包括移植的可能性和死亡的等待名单，使用竞争风险模型。计算小组反应性抗体（CPRA）被用来作为一个连续的措施allosensitization.Results：在746名候选人谁被列为肺移植在研究期间，263（35%）allosensitized，和483（65%）没有。在未校正的分析中，与非同种异体致敏的候选者相比，同种异体致敏的候选者的移植可能性降低（亚危险比[sHR]，0.71; 95%置信区间[CI]，0.60-0.83; P < 0.001），并且更可能在等待名单中死亡（sHR，1.66; 95% CI，1.08-2.58; P < 0.001）。在多变量模型中，增加CPRA与死亡风险增加和移植可能性降低相关。（死亡sHR，CPRA每增加10%为1.15; 95% CI，1.07-1.22; P，0.001;移植sHR，CPRA每增加10%为0.89; 95% CI，0.86-0.91; P < 0.001）。广泛的同种异体致敏与肺移植等待名单上的候选人的等待时间延长、移植可能性降低和死亡风险增加有关。在器官分配策略中考虑同种异体致敏可能有助于减轻高度同种异体致敏的候选人的这种增加的风险。
Rationale: Allosensitization may be a barrier to lung transplant. Currently, consideration is not given to allosensitization when assigning priority on the lung transplant waiting list.Objectives: We aimed to examine the association between allosensitization and waiting list outcomes.Methods: We conducted a retrospective single-center cohort study of adults listed for lung transplant at our center between January 1, 2006, and December 31, 2016. We screened candidates for human leukocyte antigen antibodies before listing and examined the association between allosensitization and waiting list outcomes, including likelihood of transplant and death on the waiting list, using a competing risk model. Calculated panel-reactive antibody (CPRA) was used as a continuous measure of allosensitization.Results: Among 746 candidates who were listed for lung transplant during the study period, 263 (35%) were allosensitized, and 483 (65%) were not. In unadjusted analysis, allosensitized candidates had a decreased likelihood of transplant compared with nonallosensitized candidates (subhazard ratio [sHR], 0.71; 95% confidence interval [CI], 0.60-0.83; P < 0.001) and were more likely to die on the waiting list (sHR, 1.66; 95% CI, 1.08-2.58; P < 0.001). In multivariable modeling, increasing CPRA was associated with an increased risk of death and a decreased likelihood of transplant (sHR for death, 1.15 per 10% increase in CPRA; 95% CI, 1.07-1.22; P, 0.001; sHR for transplant, 0.89 per 10% increase in CPRA; 95% CI, 0.86-0.91; P < 0.001).Conclusions: Broad allosensitization was associated with longer waiting times, decreased likelihood of transplant, and increased risk of death among candidates on the waiting list for lung transplant. Consideration of allosensitization in organ allocation strategies might help mitigate this increased risk in highly allosensitized candidates.