Ann Thorac Surg 2000;69:1524
© 2000 The Society of Thoracic Surgeons
Discussion
Discussion
DR ROSS M. UNGERLEIDER (Durham, NC): That was very nice, and you certainly know much more about this than I do, but I just have a procedural question. The last slide that you showed was one of protocol. Was that a protocol that you used throughout this study or was there perhaps a selection bias during the study? That is, were you transplanting all patients regardless of their PRA level or was there perhaps a subset of patients with high PRAs that didn’t get transplanted? I am just curious if your groups included all patients. Was that protocol you described always in effect or did it evolve because of this review?
DR LAU: Thank you, Dr Ungerleider. That is an excellent point. Patients found to have elevated pretransplant PRAs undergo prospective cross-matching. If the cross-match is positive, the patient is not transplanted. If the cross-match is negative we proceed with transplantation. This has been the protocol at our institution since the lung transplant program was started.
DR WILLIAM A. BAUMGARTNER (Baltimore, MD): I was going to ask a similar question to Dr Ungerleider. That was a great presentation, and I just had one other question. I know you alluded to it, but is there a PRA degree that is more significant than another. In other words, do you see a trend towards worse results depending on what the degree of the PRA is?
DR LAU: Thank you, Dr Baumgartner. Your point is very important. We chose a PRA greater than 10% to be high because that is the value used in much of the heart and kidney literature. Additionally Gammie and colleagues in the lung transplant literature used a PRA value of > 10% to define the high PRA group. The 1–10% group usually is not very reproducible. We had 18 patients with PRAs > 10% (median 31%, range 11–76%). We did not attempt to subdivide this high PRA group because the numbers were small, but it will be interesting to see in the future as the number of transplants at our institution increases.
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Ann. Thorac. Surg. 2000 69: 1520-1524.
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