Lung Transplantation: Making Sense of the Sensitized

Abstract

Purpose Solid phase assays detect anti-HLA antibodies with high accuracy and sensitivity, however debate continues on how these results should be interpreted in the setting of lung transplantation (LTx). Methods and Materials We performed a retrospective analysis of pre-LTx anti-HLA antibody levels detected using the Luminex assay in 158 patients undergoing LTx at a single centre between 1/8/08 and 30/10/11. All patients underwent prospective T- and B-cell crossmatches (XM) prior to LTx. Outcome variables analyzed included acute cellular and antibody-mediated rejection, BOS and survival. Results Pre-LTx class I and class II anti-HLA antibodies were present in 73/155 (47%) and 25/155 (16%) patients, respectively, but did not predict a positive T- or B-cell XM which was weekly positive in 1/158 and 25/158 patients, respectively. Class I and II donor-specific antibodies (DSA) were present pre-LTx in 27/157 (17%) and 9/157 (6%) patients, respectively. The presence pre-LTx of class I anti-HLA antibodies (OR 10, p=0.01) and HLA-Cw DSA (OR 5.6, p=0.01) predicted for AMR. In a univariate analysis BOS (HR 8.1, p Conclusions Sensitization to non-specific and donor-specific class I HLA whilst on the lung transplant waiting list is associated with poor post-LTX outcomes. Solid phase assays provide prognostic information beyond that provided by a negative prospective XM.