Evan P. Kransdorf, MD, PhD, Michelle M. Kittleson, MD, PhD, Jignesh K

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Calculated panel-reactive antibody predicts outcomes on the heart transplant waiting list Evan P. Kransdorf, MD, PhD, Michelle M. Kittleson, MD, PhD, Jignesh K. Patel, MD, PhD, Marcelo J. Pando, PhD, D. Eric Steidley, MD, Jon A. Kobashigawa, MD The Journal of Heart and Lung Transplantation Volume 36, Issue 7, Pages 787-796 (July 2017) DOI: 10.1016/j.healun.2017.02.015 Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 1 Schematic of patient selection. (A) A data set of patients listed for heart transplant with unacceptable human leukocyte antigens (UA-HLA) entered at the time of waiting list addition/modification was obtained from the United Network for Organ Sharing (UNOS). Candidates listed for transplant within years 2006 to 2013, age ≥18 years, were selected for further study. Adult candidates listed for transplant during the same time period without UA-HLA entered served as the control cohort. (B) Post-transplant outcomes were assessed for the candidates in the study cohort who received a transplant as compared with a set of candidates in the control cohort who received a transplant and had PRA Class I and Class II values of 0% (non-sensitized control). The Journal of Heart and Lung Transplantation 2017 36, 787-796DOI: (10.1016/j.healun.2017.02.015) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 2 Distribution of calculated panel-reactive antibody (CPRA) values in the study cohort. Each vertical column represents an interval of 2% CPRA. The Journal of Heart and Lung Transplantation 2017 36, 787-796DOI: (10.1016/j.healun.2017.02.015) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 3 Plot of frequency of waiting list outcomes for sensitized candidates grouped by calculated panel-reactive antibody (CPRA) value. Candidates were sorted into 5 groups by their initial CPRA value. As CPRA increased, the percentage of candidates who received a transplant decreased, and the percentage of candidates still waiting for a transplant and removed from the waiting list, or died, increased. The Journal of Heart and Lung Transplantation 2017 36, 787-796DOI: (10.1016/j.healun.2017.02.015) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 4 Competing risks analysis of waiting list outcomes for candidates grouped by calculated panel-reactive antibody (CPRA) value. (A) The cumulative incidence of heart transplantation decreases in each successively higher CPRA group. (B) The cumulative incidence of removal from the waiting list increases in the higher CPRA groups. (C) The cumulative incidence of death increases in each successively higher CPRA group. The Journal of Heart and Lung Transplantation 2017 36, 787-796DOI: (10.1016/j.healun.2017.02.015) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 5 Outcomes on the waiting list by priority status at initial listing for heart transplant for low-level sensitized (calculated panel-reactive antibody [CPRA] value <10%) and sensitized (CPRA ≥10%) candidates. As the priority status urgency at initial listing increased, the percentage of candidates still waiting or who had received a transplant increased, and the percentage of candidates who were removed from the waiting list or died decreased. For each priority status at initial listing, the percentage of sensitized candidates still waiting or who had received a transplant was significantly lower, and percent of candidates removed from the waiting list or died was significantly higher compared with low-level sensitized candidates. The Journal of Heart and Lung Transplantation 2017 36, 787-796DOI: (10.1016/j.healun.2017.02.015) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 6 Boxplot of active time on the heart transplant waiting list for candidates who received a heart transplant, grouped the initial calculated panel-reactive antibody (CPRA) value. The median waiting time is indicated above the bar within the box and increased in each successively higher CPRA group (p < 0.001). Outliers are not shown. The Journal of Heart and Lung Transplantation 2017 36, 787-796DOI: (10.1016/j.healun.2017.02.015) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 7 Active time on the heart transplant waiting list at each priority status for candidates who received a heart transplant, grouped by the initial calculated panel-reactive antibody (CPRA) value. The percent of total time at each active priority status (Status 1A, Status 1B and Status 2) differed between the 6 groups (p < 0.001). There was a trend toward increased time at Status 1B and decreased time at Status 2 as the CPRA of the group increased. The Journal of Heart and Lung Transplantation 2017 36, 787-796DOI: (10.1016/j.healun.2017.02.015) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions

Figure 8 Post-transplant survival for the 5 CPRA groups as compared with the control cohort using the Kaplan–Meier method. Survival at 3 years post-transplant differed significantly (p = 0.007). A risk table is shown below the survival curve, which depicts the number of recipients at risk in each group at the time of transplantation and at Years 1, 2 and 3. The Journal of Heart and Lung Transplantation 2017 36, 787-796DOI: (10.1016/j.healun.2017.02.015) Copyright © 2017 International Society for the Heart and Lung Transplantation Terms and Conditions