TY - JOUR
T1 - Human leukocyte antigens antibodies after lung transplantation
T2 - Primary results of the HALT study
AU - Hachem, Ramsey R.
AU - Kamoun, Malek
AU - Budev, Marie M.
AU - Askar, Medhat
AU - Ahya, Vivek N.
AU - Lee, James C.
AU - Levine, Deborah J.
AU - Pollack, Marilyn S.
AU - Dhillon, Gundeep S.
AU - Weill, David
AU - Schechtman, Kenneth B.
AU - Leard, Lorriana E.
AU - Golden, Jeffrey A.
AU - Baxter-Lowe, Lee Ann
AU - Mohanakumar, Thalachallour
AU - Tyan, Dolly B.
AU - Yusen, Roger D.
PY - 2018/9
Y1 - 2018/9
N2 - Donor-specific antibodies (DSA) to mismatched human leukocyte antigens (HLA) are associated with worse outcomes after lung transplantation. To determine the incidence and characteristics of DSA early after lung transplantation, we conducted a prospective multicenter observational study that used standardized treatment and testing protocols. Among 119 transplant recipients, 43 (36%) developed DSA: 6 (14%) developed DSA only to class I HLA, 23 (53%) developed DSA only to class II HLA, and 14 (33%) developed DSA to both class I and class II HLA. The median DSA mean fluorescence intensity (MFI) was 3197. We identified a significant association between the Lung Allocation Score and the development of DSA (HR = 1.02, 95% CI: 1.001-1.03, P =.047) and a significant association between DSA with an MFI ≥ 3000 and acute cellular rejection (ACR) grade ≥ A2 (HR = 2.11, 95% CI: 1.04-4.27, P =.039). However, we did not detect an association between DSA and survival. We conclude that DSA occur frequently early after lung transplantation, and most target class II HLA. DSA with an MFI ≥ 3000 have a significant association with ACR. Extended follow-up is necessary to determine the impact of DSA on other important outcomes.
AB - Donor-specific antibodies (DSA) to mismatched human leukocyte antigens (HLA) are associated with worse outcomes after lung transplantation. To determine the incidence and characteristics of DSA early after lung transplantation, we conducted a prospective multicenter observational study that used standardized treatment and testing protocols. Among 119 transplant recipients, 43 (36%) developed DSA: 6 (14%) developed DSA only to class I HLA, 23 (53%) developed DSA only to class II HLA, and 14 (33%) developed DSA to both class I and class II HLA. The median DSA mean fluorescence intensity (MFI) was 3197. We identified a significant association between the Lung Allocation Score and the development of DSA (HR = 1.02, 95% CI: 1.001-1.03, P =.047) and a significant association between DSA with an MFI ≥ 3000 and acute cellular rejection (ACR) grade ≥ A2 (HR = 2.11, 95% CI: 1.04-4.27, P =.039). However, we did not detect an association between DSA and survival. We conclude that DSA occur frequently early after lung transplantation, and most target class II HLA. DSA with an MFI ≥ 3000 have a significant association with ACR. Extended follow-up is necessary to determine the impact of DSA on other important outcomes.
KW - clinical research/practice
KW - histocompatibility
KW - lung transplantation/pulmonology
KW - major histocompatibility complex (MHC)
KW - monitoring: immune
KW - rejection: T cell mediated (TCMR)
KW - rejection: antibody-mediated (ABMR)
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U2 - 10.1111/ajt.14893
DO - 10.1111/ajt.14893
M3 - Article
C2 - 29687961
AN - SCOPUS:85052526898
VL - 18
SP - 2285
EP - 2294
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 9
ER -