Early clearance vs persistence of de novo donor‐specific antibodies following lung transplantation

Islam, A.; Sinha, Neeraj; DeVos, J.; Kaleekal, Thomas; Jyothula, Soma; Teeter, Larry D.; Nguyen, Duc T.; Eagar, Todd N.; Moore, Linda W.; Puppala, Mamta; Wong, Stephen T.C.; Knight, Richard J.; Frost, Adaani E.; Graviss, Edward A.; Gaber, A. Osama

doi:10.1111/ctr.13028

Cited by 26 publications

(39 citation statements)

References 22 publications

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“…Islam et al focused on early clearance and persistence of de novo DSA as well. They were able to show that patients with early clearance of DSA had significantly less acute rejections and better graft survival . Verleden et al recommended to distinguish between transient and persistent DSA .…”

Section: Discussionmentioning

confidence: 99%

“…DSA appears frequently after lung transplantation; however, the pathophysiological impact is still not completely understood . The majority of de novo DSAs appear early after lung transplantation, mostly in the first year after transplantation . In recent years, there was a growing interest in persistence as opposed to spontaneous clearance of de novo DSA .…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, there was a growing interest in persistence as opposed to spontaneous clearance of de novo DSA . Especially, persistent DSA seems to be associated with a worse outcome …”

Section: Introductionmentioning

confidence: 99%

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Persistence of de novo donor‐specific HLA‐antibodies after lung transplantation: A potential marker of decreased patient survival

Schmitzer

Winter

Kneidinger

et al. 2018

HLA

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The impact of de novo donor-specific anti-HLA antibodies (DSA) on outcomes in lung transplantation is still a matter of debate. We hypothesize that differentiating DSA by persistent and transient appearance may offer an additional risk assessment. The clinical relevance of HLA-antibodies was investigated prospectively in 72 recipients with a median follow-up period of 21 months. The presence of HLA-antibodies was analysed by single antigen bead assay prior to and after (3 weeks, 3, 6, 12 and 18 months) transplantation. In 23 patients (32%) de novo DSA were detected. In 10 of these patients (44%) DSA persisted throughout the follow-up period whereas 13 of these patients (56%) had transient DSA. There was a trend towards lower one-year-survival in DSA positive compared to DSA negative patients (83% versus 94%; p=0.199). Remarkably, patients with persistent DSA had significantly reduced survival (one-year survival 60%) compared with both patients without DSA and those with transient DSA (p=0.005). Persistent DSA represented an independent prognostic factor for reduced overall survival in multivariate analysis (HR 8.3, 95% CI 1.8-37.0; p=0.006). Persistence of DSA during the first year after transplantation seems to be more harmful for lung allograft function than transiently detected DSA at an early stage. This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Persistence of de novo donor‐specific HLA‐antibodies after lung transplantation: A potential marker of decreased patient survival

Schmitzer

Winter

Kneidinger

et al. 2018

HLA

View full text Add to dashboard Cite

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“…Given the interaction between PGD and cardiopulmonary bypass (CPB), the results were presented before and after adjusting for CPB. Because of the risk of DQ‐DSA on adverse outcomes, we performed a subgroup analysis to identify risk factors for developing DQ‐DSA . Similar multivariable models were evaluated as described previously, for the development of DQ‐DSA.…”

Section: Methodsmentioning

confidence: 99%

“…These data underscore the role of humoral immune responses in lung allograft rejection. Previous studies have identified risk factors for the development of DSA including pretransplant allosensitization, retransplantation, the lung allocation score (LAS), and primary graft dysfunction (PGD) . The associations of LAS and PGD with DSA suggest that proinflammatory events early after transplantation increase the risk of DSA development.…”

Section: Introductionmentioning

confidence: 99%

Pseudomonas aeruginosa and acute rejection independently increase the risk of donor-specific antibodies after lung transplantation

Kulkarni

Tsui

Sunder

et al. 2020

American Journal of Transplantation

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Factors contributing to donor‐specific HLA antibody (DSA) development after lung transplantation have not been systematically evaluated. We hypothesized that the isolation of Pseudomonas aeruginosa in respiratory specimens would increase the risk of DSA development. Our objective was to determine the risk of DSA development associated with the isolation of Pseudomonas aeruginosa after lung transplantation. We conducted a single‐center retrospective cohort study of primary lung transplant recipients and examined risk factors for DSA development using Cox regression models. Of 460 recipients, 205 (45%) developed DSA; the majority developed Class II DSA (n = 175, 85%), and 145 of 205 (71%) developed DSA to HLA‐DQ alleles. Univariate time‐dependent analyses revealed that isolation of Pseudomonas from respiratory specimens, acute cellular rejection, and lymphocytic bronchiolitis are associated with an increased risk of DSA development. In multivariable analyses, Pseudomonas isolation, acute cellular rejection, and lymphocytic bronchiolitis remained independent risk factors for DSA development. Additionally, there was a direct association between the number of positive Pseudomonas cultures and the risk of DSA development. Our findings suggest that pro‐inflammatory events including acute cellular rejection, lymphocytic bronchiolitis, and Pseudomonas isolation after transplantation are associated with an increased risk of DSA development.

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HLAand Antigen Receptor Biology

Bery,

Kreisel,

Kulkarni

2023

Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease

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Early clearance vs persistence of de novo donor‐specific antibodies following lung transplantation

Abstract: Early post-lung transplantation, dnDSA occurred in 1/4 of recipients, was associated with peri-transplant risk factors and resulted in decreased survival. Spontaneous clearance of dnDSA, seen in one-third of recipients, was associated with a lower risk of acute rejection.

Cited by 26 publications

References 22 publications

Persistence of de novo donor‐specific HLA‐antibodies after lung transplantation: A potential marker of decreased patient survival

Persistence of de novo donor‐specific HLA‐antibodies after lung transplantation: A potential marker of decreased patient survival

Pseudomonas aeruginosa and acute rejection independently increase the risk of donor-specific antibodies after lung transplantation

HLAand Antigen Receptor Biology

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