Accessing the Impacts of the Calculated Panel Reactive Antibody Value on a Lung Transplant Waitlist: A Latin American Experience

<b>Backgorund\Objectives:</b> Lung transplantation is the definitive treatment for select patients with end-stage pulmonary diseases. However, immunologic sensitization, as measured by calculated panel-reactive antibody (cPRA), poses significant challenges to transplant access and outcomes. This study aimed to evaluate the impact of cPRA on lung transplantation waitlist dynamics in a single-center cohort in Brazil, focusing on its association with waitlist mortality, delisting, and transplantation. <b>Methods:</b> A retrospective cohort study was conducted including all lung transplant candidates listed in our institution between January 2012 and December 2022. Candidates were stratified by cPRA values at listing into five groups: 0%, 0.1-25%, 25.1-50%, 50.1-75%, and 75.1-100%. Primary outcomes included lung transplantation, with secondary outcomes of waitlist mortality and delisting due to clinical deterioration. Statistical comparisons were performed, as appropriate. <b>Results:</b> Of the 411 candidates evaluated, 327 met the inclusion criteria. Among them, 100 (30.6%) were sensitized (cPRA > 0%), with increasing cPRA values correlating with longer median waitlist times (<i>p</i> < 0.01). Although transplantation rates were not statistically different across the cPRA strata (<i>p</i> = 0.277), the group with a cPRA > 75% had the lowest transplant rate (37.5%). Waitlist mortality was significantly higher in candidates with a cPRA > 50% (<i>p</i> = 0.047), whereas delisting rates did not differ across groups (<i>p</i> = 0.722). <b>Conclusions:</b> Elevated cPRA is associated with prolonged waitlist time and increased mortality, reflecting both immunologic and logistical barriers to lung transplantation. These findings support the need for incorporating cPRA into allocation policies and adopting targeted strategies, such as desensitization protocols, to improve equity in transplant access for sensitized patients, particularly in genetically diverse populations. Further multicenter studies are warranted to validate these results and inform policy development.