Lung Transplantation and the Era of the Sensitized Patient.

Katherine A Young,Kristi J Beermann,Hakim A Ali,John M Reynolds,Laurie D Snyder

doi:10.3389/fimmu.2021.689420

Katherine A Young, Kristi J Beermann + Show 3 more

Open Access

https://doi.org/10.3389/fimmu.2021.689420

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Abstract

Highlights

Lung transplantation has become the definitive treatment for many patients with end-stage lung disease
The two most common chronic lung allograft dysfunction (CLAD) phenotypes include an obstructive phenotype called bronchiolitis obliterans syndrome (BOS), defined by a drop in FEV1 but initially preserved functional vital capacity (FVC) and/or preserved total lung capacity (TLC) and a restrictive phenotype called restrictive CLAD/restrictive allograft syndrome which is characterized by decline in FVC and/ or TLC in addition to the FEV1 decline [2]
Antibody-mediated rejection (AMR) or activation of humoral immunity is being recognized as a separate risk factor for poor long-term outcomes in solid organ transplantation and is considered a risk factor for CLAD in lung transplant recipients [3, 4, 6, 7]

Summary

Lung Transplantation and the Era of the Sensitized Patient

Long term outcomes in lung transplant are limited by the development of chronic lung allograft dysfunction (CLAD). Within the past several decades, antibody-mediated rejection (AMR) has been recognized as a risk factor for CLAD. The presence of HLA antibodies in lung transplant candidates, “sensitized patients” may predispose patients to AMR, CLAD, and higher mortality after transplant. This review will discuss issues surrounding the sensitized patient, including mechanisms of sensitization, implications within lung transplant, and management strategies. Reviewed by: Rhonda Holdsworth, Australian Red Cross Blood Service, Australia Jakob Nilsson, University Hospital Zürich, Switzerland. Specialty section: This article was submitted to Alloimmunity and Transplantation, a section of the journal Frontiers in Immunology. Lung Transplantation and the Era of the Sensitized Patient.

INTRODUCTION

OVERVIEW OF AMR MECHANISM IN LUNG TRANSPLANT

CONSIDERATIONS FOR POLICY CHANGES

Findings

DISCUSSION