(419) - Postoperative Donor Specific Anti-HLA Antibodies in Lung Transplantation: Risk Factors and Impact on Mid-Term Patient and Graft Outcomes

Abstract

After lung transplantation the impact of donor specific anti-HLA antibodies (DSA) on patient and graft survival is still controversial. Aim of this study was to analyze the risk factors for DSA development and to compare mid-term outcomes in patients with or without DSA. Between January 2009 and August 2013, 544 patients underwent lung transplantation at our Institution. Ninety-seven (18%) patients showed DSA postoperatively (Group A), 447 (82%) patients (Group B) did not. DSA were detected by the Luminex assay. Patient postoperative and follow-up records were retrospectively reviewed. Binary logistic regression analysis was used to identify independent risk factors for DSA development and overall mortality. Re-transplantation (OR=2.5; 95% confidence interval [CI] 1.1 to 5.7 p=0.03), preoperative anti-HLA antibodies (OR=2.0; 95% CI 1.2 to 3.2 p=0.008) and primary graft dysfunction (PGD) score grade 2-3 at 48 hours after transplantation (OR=2.7; 95% CI 1.6 to 4.8 p < 0.01) were independent risk factors for postoperative DSA development. Mean follow-up was 23±16 months. At 1 and 3 years, overall survival (%) was 78±4.5 vs 88±2 and 57±8 vs 74±3, in Group A and B, respectively (p=0.01). Only postoperative dialysis (OR=44; 95% CI 4 to 525 p = 0.003) and acute rejection (OR=9; 95% CI 1.2 to 67.2 p = 0.03) were independent risk factors for mortality. At 1 and 3 years freedom from BOS (%) grade 1-3 was 84±4 vs 90±1 and 55±9 vs 51±3 (p = 0.5), and from acute rejection (%) 47±6 vs 45±3 and 37±8 vs 26±3 (p = 0.18), in Group A and B, respectively. At 1-year follow-up, forced expiratory volume at 1 second (% threshold) was 75±19 vs 82±24, in Group A and B, respectively (p = 0.09). Patients with preoperative antibodies or re-transplantation are at higher risk for developing DSA postoperatively. Primary graft dysfunction augments DSA development. While patient survival differs significantly between groups, multivariate analysis does not detect DSA as independent risk factor. Further study on the role of DSA after lung transplantation is warranted.