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The Presence of Pretransplant HLA Antibodies Does Not Impact the Development of Chronic Lung Allograft Dysfunction or CLAD-Related Death.
Transplantation. 2017 09; 101(9):2207-2212.T

Abstract

BACKGROUND

Development of donor-specific antibodies (DSA) after lung transplantation is associated with antibody mediated rejection, acute cellular rejection, and bronchiolitis obliterans syndrome; however, the significance of circulating antibodies before transplant remains unclear.

METHODS

We performed a retrospective cohort study including recipients of primary lung transplants between 2008 and 2012. We assessed the impact of circulating HLA and noncytotoxic DSA detected before transplant on development of Chronic Lung Allograft Dysfunction (CLAD) or CLAD-related death.

RESULTS

30% of subjects had circulating class I antibodies alone, 4% Class II, and 14.4% class I and class II at mean fluorescent intensity greater than 1000. Nine percent of the subjects had DSA class I, 9% class II, and 2.4% both DSA classes 1 and 2. Neither the presence of circulating antibodies (adjusted hazard ratio, 0.87; 95% confidence interval, 0.50-1.54) nor the presence of DSA (adjusted hazard ratio, 1.56; 95% confidence interval, 0.77-3.18) before transplant at mean fluorescent intensity greater than 1000 was associated with the development of CLAD or CLAD-related death.

CONCLUSIONS

Although in previous studies we have shown an increased incidence of antibody-mediated rejection in patients with pretransplant DSA, neither the presence of HLA antibodies nor DSA translated to an increased risk of allograft dysfunction or death if prospective crossmatch testing was negative. Prospective studies are needed to define the impact of pretransplant sensitization on lung transplant recipients.

Authors+Show Affiliations

1 Lung Transplant Program, Pulmonary and Critical Care Medicine Division, Brigham and Women's Hospital, Boston, MA. 2 Heart Transplant Program, Center for Advanced Heart Disease, Division of Cardiology, Brigham and Women's Hospital, Boston, MA. 3 Department of Pharmacy, Brigham and Women's Hospital, Boston, MA. 4 Clinical Laboratory Division, Tissue Typing Laboratory, Brigham and Women's Hospital, Boston, MA. 5 Harvard Medical School, Boston, MA. 6 Renal Transplant Program, Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA. 7 Lung Transplant Program, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27893614

Citation

Zazueta, Oscar E., et al. "The Presence of Pretransplant HLA Antibodies Does Not Impact the Development of Chronic Lung Allograft Dysfunction or CLAD-Related Death." Transplantation, vol. 101, no. 9, 2017, pp. 2207-2212.
Zazueta OE, Preston SE, Moniodis A, et al. The Presence of Pretransplant HLA Antibodies Does Not Impact the Development of Chronic Lung Allograft Dysfunction or CLAD-Related Death. Transplantation. 2017;101(9):2207-2212.
Zazueta, O. E., Preston, S. E., Moniodis, A., Fried, S., Kim, M., Townsend, K., Wood, I., Boukedes, S., Guleria, I., Camp, P., El-Chemaly, S., Rosas, I. O., Chandraker, A., Milford, E., & Goldberg, H. J. (2017). The Presence of Pretransplant HLA Antibodies Does Not Impact the Development of Chronic Lung Allograft Dysfunction or CLAD-Related Death. Transplantation, 101(9), 2207-2212. https://doi.org/10.1097/TP.0000000000001494
Zazueta OE, et al. The Presence of Pretransplant HLA Antibodies Does Not Impact the Development of Chronic Lung Allograft Dysfunction or CLAD-Related Death. Transplantation. 2017;101(9):2207-2212. PubMed PMID: 27893614.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Presence of Pretransplant HLA Antibodies Does Not Impact the Development of Chronic Lung Allograft Dysfunction or CLAD-Related Death. AU - Zazueta,Oscar E, AU - Preston,Sara E, AU - Moniodis,Anna, AU - Fried,Sabrina, AU - Kim,Miae, AU - Townsend,Keri, AU - Wood,Isabelle, AU - Boukedes,Steve, AU - Guleria,Indira, AU - Camp,Phillip, AU - El-Chemaly,Souheil, AU - Rosas,Ivan O, AU - Chandraker,Anil, AU - Milford,Edgar, AU - Goldberg,Hilary J, PY - 2016/11/29/pubmed PY - 2017/10/11/medline PY - 2016/11/29/entrez SP - 2207 EP - 2212 JF - Transplantation JO - Transplantation VL - 101 IS - 9 N2 - BACKGROUND: Development of donor-specific antibodies (DSA) after lung transplantation is associated with antibody mediated rejection, acute cellular rejection, and bronchiolitis obliterans syndrome; however, the significance of circulating antibodies before transplant remains unclear. METHODS: We performed a retrospective cohort study including recipients of primary lung transplants between 2008 and 2012. We assessed the impact of circulating HLA and noncytotoxic DSA detected before transplant on development of Chronic Lung Allograft Dysfunction (CLAD) or CLAD-related death. RESULTS: 30% of subjects had circulating class I antibodies alone, 4% Class II, and 14.4% class I and class II at mean fluorescent intensity greater than 1000. Nine percent of the subjects had DSA class I, 9% class II, and 2.4% both DSA classes 1 and 2. Neither the presence of circulating antibodies (adjusted hazard ratio, 0.87; 95% confidence interval, 0.50-1.54) nor the presence of DSA (adjusted hazard ratio, 1.56; 95% confidence interval, 0.77-3.18) before transplant at mean fluorescent intensity greater than 1000 was associated with the development of CLAD or CLAD-related death. CONCLUSIONS: Although in previous studies we have shown an increased incidence of antibody-mediated rejection in patients with pretransplant DSA, neither the presence of HLA antibodies nor DSA translated to an increased risk of allograft dysfunction or death if prospective crossmatch testing was negative. Prospective studies are needed to define the impact of pretransplant sensitization on lung transplant recipients. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/27893614/The_Presence_of_Pretransplant_HLA_Antibodies_Does_Not_Impact_the_Development_of_Chronic_Lung_Allograft_Dysfunction_or_CLAD_Related_Death_ L2 - http://dx.doi.org/10.1097/TP.0000000000001494 DB - PRIME DP - Unbound Medicine ER -