Influence of Panel Reactive Antibodies (PRA) on Perioperative Course in Patients Undergoing Elective Cardiac Surgery Procedures, and Impact of these Procedures on PRA Occurrence
Michal Zakliczynski, Lukasz Pyka, Dominika Trybunia, Anna Krynicka, Piotr Wilczek, Marcin Maruszewski, Pawel Nadziakiewicz, Miroslawa Herdynska-Was, Roman Przybylski, Marian Zembala
Ann Transplant 2006; 11(4): 4-11
Available online: 2006-12-08
Background: Cardiac surgery is supposed to be a risk factor of PRA formation, however the role of PRA presence in non-transplant subjects is not known. Aim of the study was to assess PRA occurrence in patients undergoing elective cardiosurgery procedures and to evaluate its influence on the perioperative course. Material and methods: Blood samples were obtained before operation in 44 subjects (36M/8F; 55.9±8.1y/o) undergoing primary elective cardiosurgery procedures – CABG (n=30), CABG + valve (n=2) or valve procedure (n=12). PRA results were obtained after the discharge, and patients were retrospectively divided into: Group A (n=18) with PRA>1%, and Group B (n=26) with PRA.≤1%. PRA screening was repeated 3 months after the procedure in 41 subjects. They were divided into Group I (n=13) with PRA>1%, and Group II (n=28) with PRA≤1%. Comparison was performed of Groups A vs. B, and I vs. II. Results: Differences in pre-operative characteristics and procedure type distribution were insignificant. Post-operative complications were more frequent in Groups A and I (pulmonary hypertension in Group I vs. II: 38 vs. 4%; p=0,01). Duration of post-operative ICU stay was longer in Group I vs. II (2.9 vs. 1.9d.; p=0.01). Overall hospital stay was longer in Group A vs. B (10.1 vs. 7.8d.; p=0.054). Increase of PRA titers was observed in 10 subjects (3 pts. /17% from Group A, and 7 pts. /27% from Group B), exceeding 10% in 2 females after valve replacement. 6 months after procedure, detectable PRA was still observed in 7 patients. Conclusions: Cardiac surgery is not a strong causative factor of PRA formation. The presence of perceptible PRA level may be associated with increased incidence of complications and consequently prolonged in-hospital stay. Influence of PRA on peri-operative course is not dependent on the source of its increased level.
Keywords: Cardiac Surgery Complications, Human Leukocyte Antigen (HLA), Panel Reactive Antibody (PRA)