Impact of AMR Treatment on Graft Function in Lung Transplant Recipients

Abstract

Purpose Antibody mediated rejection (AMR) is increasingly recognized as a damaging process conducing lung transplant (LTX) recipients to chronic lung allograft dysfunction and severely impacting the prognostic of the patients. Until now, few treatments are effective for AMR. The aim of the study was to assess retrospectively the effect of a treatment combining plasma exchange therapy (PFX), intravenous immunoglobulin (IVIg) and rituximab (RTX) on graft function in patients with AMR. Methods AMR was diagnosed according to combination of criteria including allograft dysfunction, pathological findings (complement deposition, AFOP or DAD) and positive serology for anti-HLA donor specific antibodies. Statistical analysis were performed using paired t test or ANOVA. Results Between 1/1/2013 and 31/12/2017, 40 lung transplant recipients were treated for AMR (94/2/2/2% double LTX, single LTX, heart-LTX, liver-LTX; 42% COPD, 21% CF, 25% ILD, 6% PAH, 6% other) in UZ Leuven, Belgium. Median duration between LTX and AMR was 1205 days (13-6086). A mean of 6±1 plasma exchanges was performed per patient. At follow up, 6 (15%) patients were re-transplanted and 18 (45%) died. Lost of graft (death plus redo LTX) was 62% at 1 year after ending PFX. FEV1 declined the 6 months before AMR treatment but stopped to decline significantly during the 6 months after combination therapy (627±537ml and 53±434ml, p Conclusion Survival after AMR is poor. PFX, IVIg and RTX may stabilize lung function in good responders.