Developing DSA Post-Lung Transplant - Identifying Risk Factors

Abstract

Purpose Donor specific antibodies (DSA) to mismatched human leukocyte antigens have been reported to adversely affect the outcomes of lung transplantation. This study aimed to identify the risk factors for the development of DSA within 1-year post-transplant and examine its impact on recipients’ medium-term survival. Methods Recipients’ age, type of transplantation (single lung or bilateral lungs), pre-existing antibodies, post-op DSA, method of transplantation (ECMO, off-pump or on-pump), primary graft failure (PGD) grade 3 at 72hrs, blood transfusion, post-op ITU stay, ECMO usage and renal support, and survival status were collected from the unit's database. Binary logistic regression was used to identify risk factors for the development of post-op DSA within 1-year post-transplant. Multivariable Cox regression was performed to identify risk factors for survival. Results From January 2012 to October 2017, 259 adult patients received lung transplantation in our unit and 242 (93.4%) survived beyond 30-day post-op. Recipients who died within 30-day post-transplant were not included, as the causes of their death were less likely to be influenced by or associated with post-op DSA. Among these 242 recipients, 46 (19.0%) had pre-existing antibodies and 129 (53.3%) had DSA detected within 1-year post-transplant. Among all the potential risk factors, transplantation performed with ECMO (p = 0.007, OR 3.06, 95% CI: 1.36-6.90) are significantly associated with post-op DSA within 1-year post-transplant. Age (p = 0.009, OR 1.03, 95% CI: 1.01-1.05), post-op renal support (p = 0.015, OR 2.23, 95% CI: 1.17-4.26), PGD grade 3 at 72hrs (p = 0.001, OR 2.79, 95% CI: 1.54-5.05), and red blood cell transfusion (p < 0.001, OR 1.17, 95% CI: 1.11-1.23) are associated with worse medium-term survival, but neither pre-existing antibodies (p = 0.454) or post-op DSA (p = 0.479) has an impact on survival. Conclusion Use of ECMO for lung transplantation is associated with DSA development within 1-year post-transplantation. However, the presence of DSA within 1-year post-transplant has no impact on medium-term survival in this cohort. Further study is required to look at the effect of DSA on the development of chronic lung allograft dysfunction and long-term survival. Donor specific antibodies (DSA) to mismatched human leukocyte antigens have been reported to adversely affect the outcomes of lung transplantation. This study aimed to identify the risk factors for the development of DSA within 1-year post-transplant and examine its impact on recipients’ medium-term survival. Recipients’ age, type of transplantation (single lung or bilateral lungs), pre-existing antibodies, post-op DSA, method of transplantation (ECMO, off-pump or on-pump), primary graft failure (PGD) grade 3 at 72hrs, blood transfusion, post-op ITU stay, ECMO usage and renal support, and survival status were collected from the unit's database. Binary logistic regression was used to identify risk factors for the development of post-op DSA within 1-year post-transplant. Multivariable Cox regression was performed to identify risk factors for survival. From January 2012 to October 2017, 259 adult patients received lung transplantation in our unit and 242 (93.4%) survived beyond 30-day post-op. Recipients who died within 30-day post-transplant were not included, as the causes of their death were less likely to be influenced by or associated with post-op DSA. Among these 242 recipients, 46 (19.0%) had pre-existing antibodies and 129 (53.3%) had DSA detected within 1-year post-transplant. Among all the potential risk factors, transplantation performed with ECMO (p = 0.007, OR 3.06, 95% CI: 1.36-6.90) are significantly associated with post-op DSA within 1-year post-transplant. Age (p = 0.009, OR 1.03, 95% CI: 1.01-1.05), post-op renal support (p = 0.015, OR 2.23, 95% CI: 1.17-4.26), PGD grade 3 at 72hrs (p = 0.001, OR 2.79, 95% CI: 1.54-5.05), and red blood cell transfusion (p < 0.001, OR 1.17, 95% CI: 1.11-1.23) are associated with worse medium-term survival, but neither pre-existing antibodies (p = 0.454) or post-op DSA (p = 0.479) has an impact on survival. Use of ECMO for lung transplantation is associated with DSA development within 1-year post-transplantation. However, the presence of DSA within 1-year post-transplant has no impact on medium-term survival in this cohort. Further study is required to look at the effect of DSA on the development of chronic lung allograft dysfunction and long-term survival.