Abstract
Although donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) are frequently found in recipients after lung transplantation (LT), the characteristics of DSA which influence antibody-mediated rejection (AMR) in LT are not fully defined. We retrospectively analyzed 206 consecutive LT patients of our center (2010–2013). DSAs were detected by using luminex single antigen beads assay and mean fluorescence intensity was assessed. Within the study population, 105 patients had positive DSA. Patients with and without AMR (AMRPos, n = 22, and AMRNeg, n = 83, respectively) were compared. AMRPos patients had significantly greater frequencies of anti-HLA DQ DSA (DQ DSA) than AMRNeg patients (95 vs 58%, respectively, p < 0.0001). Compared to AMRNeg patients, AMRPos patients had higher DQ DSA sum MFI [7,332 (2,067–10,213) vs 681 (0–1,887), p < 0.0001]. DQ DSA when associated with AMR, had more frequent graft loss and chronic lung allograft dysfunction (CLAD). These data suggest (i) that DSA characteristics clearly differ between AMRPos and AMRNeg patients and (ii) the deleterious impact of DQ DSA on clinical outcome.
Highlights
The role of donor-specific anti-human leukocyte antigen (HLA) antibody (DSA) in graft failure via antibody-mediated rejection (AMR) and sub-clinical chronic AMR has been widely established in kidney transplantation [1,2,3] and heart transplantation [4] (KT and HT, respectively)
Tikkanen et al showed that HLA DQ mismatch and subsequent DQ DSA were associated with chronic lung allograft dysfunction (CLAD), yet the results did not show if the mean fluorescence intensity (MFI) was associated with poor graft outcome [11]
AMRPos and AMRNeg patients did not differ for clinical baseline characteristics except for the number of HLA mismatches, which was higher in AMRPos patients (Table 2)
Summary
The role of donor-specific anti-human leukocyte antigen (HLA) antibody (DSA) in graft failure via antibody-mediated rejection (AMR) and sub-clinical chronic AMR has been widely established in kidney transplantation [1,2,3] and heart transplantation [4] (KT and HT, respectively). Two retrospective analyses of KT cohorts [8, 9] have shown that presence of pre-transplant (preTx) DSA and MFI of the immunodominant DSA (understood as the DSA with the highest MFI for a given patient) were associated with graft loss. These publications did not further describe DSA either post-transplant (postTx) or at the moment of AMR. These studies did not integrate potential AMR occurrence associated with DQ DSA for the analysis of graft outcome
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