P084 De novo HLA-DQ donor specific antibodies are associated with worse long term allograft survival after lung transplantation

Abstract

Aim The long term graft survival of lung transplantation remains significantly worse than any other solid organ transplants. De novo HLA donor specific antibodies (dnDSA) have been implicated with antibody-mediated rejection (AMR), a recognized cause of allograft dysfunction in lung transplant recipients. It remains unclear what dnDSA against specific HLA antigens play in long term graft function and patient survival. We have observed that HLA class II dnDSA are common in lung transplant recipients. In this study, we further characterized that HLA dnDSA implicated allograft function and recipient survival. Methods We retrospectively investigated lung transplant recipients received transplantation between Jan, 2004 and December, 2015 in a single center. HLA DSA were tested using Luminex LabSceeen single antigen bead assays per recipient’s clinical indications. Graft function and patient survival were followed up until December 31, 2016. Data were analyzed using cox hazards regression model and logistic regression. Results A total of 187 patients were followed up for a median of 2.67 years (1–12 years). Among them, 54% were female and 46%, male and 78% were Caucasians. Fifty-eight (31%) patients developed dnDSA, i.e., 8 (4.2%) class I, 42 (22.4%) class II and 8 (4.2%) class I and class II DSA, respectively. Among these DSA positive patients, 36 (62%) patients developed HLA-DQ DSA. Both Class II dnDSA and/or DQ DSA were significantly associated with worse allograft survival and patient survival (P Conclusions HLA-DQ dnDSA are dominate in lung transplant recipients after transplantation which are associated with worse long term allograft and recipient survival. To prevent HLA-DQ dnDSA by better HLA-DQ match or to properly treat patients with HLA-DQ dnDSA may improve long term outcomes for lung transplant recipients.