Purpose: Panel-Reactive Antibody (PRA) is a screening test for a range of known human leukocyte antigens which signifies the proportion of the population that the patient being tested will react via pre-existing antibodies. The purpose of this study was to determine the impact of pretransplant PRA level on ocular surface stem cell survival and visual outcomes.

Methods: We performed a retrospective chart review of 389 eyes that underwent ocular surface stem cell transplant (OSST) by a single surgeon (EJH) between May 2000 and January 2016. All patients with pre-transplant PRA level testing were included. Patient were divided into three subgroups based on peak PRA: PRA 0%, PRA ≤ 50%, and PRA > 50%. Preoperative and last follow-up visual acuity (VA), improvement in VA, and ocular surface stability were outcome measures. Ocular surface was classified as “stable” for no recurrence of limbal stem cell defiency; “partially failed” ocular surface was defined as an eye with areas of abnormal conjunctival epithelium on the cornea and regions of normal looking cornea; ocular surface “failure” was defined as total compromise of the ocular surface. Outcomes were analyzed with ANOVA, Chi-Sqaure, Relative Risk, and Regression.

Results: A total of 51 eyes from 41 patients (56% male, mean age 40.4 years) underwent OSST with mean follow-up of 3.2 years after OSST. PRA subgroups included PRA 0% (n=28), PRA ≤ 50% (n=8), and PRA > 50% (n=15). In the 0% PRA category, 67% were stable, 22% were partial failure, and only 11% were failed; for 1-50% PRA, 56% were stable, 44% were partial failure, and 0% failed; for 51-100% PRA, 62.5% were stable, 25% were partial failure, and only 12.5% were failures. There were no significant differences between subgroups when comparing visual acuity or ocular surface stability outcomes.

Conclusion: There was no significant difference in visual acuity or ocular surface stability outcomes between high or moderate PRA eyes and those with zero PRA. Absolute failure rates for ocular surface were low even for eyes with high PRA with our current systemic immunosuppression protocol. Systemic immunosuppression adjusted for increased PRA level may help counteract any subgroup differences.

CITATION INFORMATION: Govil A, Cheung A, Sarnicola E, Genereux B, Holland E. Impact of Pretransplant Panel-Reactive Antibody Level on Ocular Surface Stem Cell Survival and Visual Outcome. Am J Transplant. 2017;17 (suppl 3).

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