1.2000
#63-OR
ROLE OF FLOW CYTOMETRY TO DEFINE DONORS WITH UNACCEPTABLE HLA ANTIGENS FOR SENSITIZED LUNG TRANSPLANT CANDIDATES.
James Z. Appel, Barbara O. Burgess, Walter F. Herczyk, Ed Cantu, Matthew G. Hartiwg, Scott M. Palmer, R. Duane Davis and Nancy L. Reinsmoen. Durham NC, USA, Duke University Medical Center, 27710, Surgery, Pathology, and Pulmonology.

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Purpose: Humoral sensitization to HLA antigens has been associated with postoperative morbidity and bronchiolitis obliterans syndrome (BOS) in lung transplant (LTX) recipients. Traditionally, sensitized LTX candidates have undergone prospective crossmatching to identify donors with unacceptable HLA antigens. FlowPRA (OneLambda), which enables the precise determination of anti-HLA specificity, was compared to prospective crossmatching to exclude donors with unacceptable HLA antigens for sensitized LTX candidates.
Methods: 439 LTX recipients were analyzed retrospectively (April, 1992–July, 2003). Of these, 18 sensitized patients underwent transplantation based on FlowPRA determination of anti-HLA specificity and 22 underwent prospective donor-recipient crossmatching.
Results: Freedom from BOS at 2 years was similar for patients undergoing lung transplantation based on FlowPRA analysis compared to those with a prospective crossmatch and those without anti-HLA antibodies (83.3%±10.8, 81.9%±9.5, and 72.7%±2.7, respectively, p=0.69). 2-year survival was also similar (85.7%±13.2, 72.7%±9.5, 72.2%±2.4, p=0.52). Elimination of prospective crossmatching was associated with a decrease in waiting list time (219 days±155 vs. 619 days±439, p<0.001) and a trend toward less waiting list mortality (7.7% vs. 37.5%, p=0.07) for sensitized patients.
Conclusions: Precise determination of antibody specificity by FlowPRA can be used to safely exclude donors with unacceptable HLA antigens for sensitized LTX candidates. This strategy obviates the utility for prospective crossmatching and decreases waiting list time and mortality.