The New View of Pre-Lung Transplant Determinants for Predicting De Novo Donor Specific Antibody and Transplant Rejection

Abstract

Purpose New era of histocompatibility risk assessment for organ transplantation has been extended from HLA to non-HLA and from antigen to epitope targets. De novo HLA donor-specific antibody (dDSA) after lung transplant (LuT) is prevalent and associated with poorer transplant outcomes. We investigated the impact of HLA-Epitope Mismatch Load (EpiMML) and preformed non-HLA auto antibody (pAuAb) to development of dDSA and rejections. Methods We retrospectively analyzed 572 recipients with LuT during 10/2012-10/2017 for the formation of dDSA. EpiMMLs were determined by HLA-Matchmaker (Version 02) among 242 recipients who had four-digit high resolution typing. pAuAbs were detected among a subgroup of 118 patients. Acute Cellular Rejection (ACR) and Antibody Mediated Rejection (AMR) were assessed for LuT outcomes. Results EpiMMLs for HLA-A, B, C, DR, and DQ were all significantly higher from patients with positive dDSA than from patients with negative dDSA (Table 1a). pAuAbs to Angiotensinogen and Vimentin were clearly related to the formation of dDSA (p Conclusion EpiMML and pAuAbs provided a more accurate and broader perspective for predicting dDSA at pre-LuT time, which may guide donor selection and optimize post-transplant immune suppression to reduce the risk of ACR and AMR related negative impact to transplantation.