Postoperative outcomes of lung transplant recipients with preformed donor-specific antibodies

Abstract

OBJECTIVES Few studies have evaluated the outcomes of lung transplantation (LTx) in recipients with preformed donor-specific antibodies (DSAs). This study investigated the postoperative changes in preformed DSAs based on prospectively collected data of DSAs, and the influences of preformed DSAs on postoperative outcomes among LTx recipients. METHODS Between July 2010 and December 2019, 216 recipients underwent LTx (81 living-donor lobar lung transplants and 135 deceased-donor lung transplants). We reviewed 8 cases with preformed DSAs to determine postoperative changes in DSAs and compared postoperative outcomes between recipients with and without DSAs. RESULTS The preoperative mean fluorescence intensity of preformed DSAs ranged from 1141 to 14 695. Two recipients experienced antibody-mediated rejection within 2 weeks after LTx. DSAs disappeared in 7 recipients; however, 1 recipient experienced the relapse of DSAs and died from chronic lung allograft syndrome (CLAD), whereas 1 recipient had persisting DSAs within the study period and died from CLAD. Neither overall survival (OS) nor CLAD-free survival was significantly different between recipients with and without DSAs (P = 0.26 and P = 0.17, respectively). However, both OS and CLAD-free survival were significantly lower in recipients with DSAs against HLA class II than in those without these antibodies {5-year OS: 25.0% [95% confidence interval (CI): 0.9–66.5%] vs 72.1% (95% CI: 63.8–78.9%), P = 0.030 and 5-year CLAD-free survival: 26.7% (95% CI: 1.0–68.6%) vs 73.7% (95% CI: 66.5–79.5%), P = 0.002}. CONCLUSIONS Prognosis in recipients experiencing the relapse of preformed DSAs and those with persisting DSAs may be poor. The recipients with anti-HLA class II preformed DSAs had a significantly worse prognosis.

Lung transplantation outcomes after crossing low‐level donor specific antibodies without planned augmented immunosuppression

“…Our primary outcome findings were in keeping with earlier studies in which pre‐transplant DSA was not associated with graft failure and/or CLAD development 7,17 . In both of these cases, however, recipients with pre‐transplant DSA were treated with pre‐ or perioperative plasmapheresis plus IVIG and/or ATG 17,7 In contrast to Kayakwake et al., we did not find an association with crossing DSA and worse CLAD‐free survival 20 . Overall, our experience suggests that acceptable graft and CLAD‐free survival can be achieved among candidates with low‐level pre‐transplant DSA without the infectious risks of pre‐transplant desensitization or post‐transplant augmented immunosuppression 4,5 .…”

“…7,17 In both of these cases, however, recipients with pre-transplant DSA were treated with pre-or perioperative plasmapheresis plus IVIG and/or ATG 17,7 In contrast to Kayakwake et al, we did not find an association with crossing DSA and worse CLAD-free survival. 20 Overall, our experience suggests that acceptable graft and CLAD-free survival can be achieved among candidates with low-level pre-transplant DSA without the infectious risks of pre-transplant desensitization or post-transplant augmented immunosuppression. 4,5 In addition, avoidance of IVIG and plasmapheresis, particularly in the early post-operative period, may reduce the risk of bleeding/thrombosis associated with these interventions.…”

Impacts of single nucleotide polymorphisms in Fc gamma receptor IIA ( rs1801274 ) on lung transplant outcomes among Japanese lung transplant recipients

“…Second, this study included a relatively large number of recipients undergoing LDLLT because of the severe donor shortage in Japan. Thus, the characteristics of recipients in this study may differ from other studies [44].…”

Immune processes in the pathogenesis of chronic lung allograft dysfunction: identifying the missing pieces of the puzzle

“…Detailed examination of DSA characteristics identified a greater risk for AMR, BOS and allograft loss in patients with DSAs against class II MHC molecules, especially DQ, compared to class I [40,44,55,56].…”