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Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation.
Clin Transplant. 2017 08; 31(8)CT

Abstract

BACKGROUND

The natural history of de novo donor-specific antibodies (dnDSA) after lung transplantation is not well-described. We sought to determine the incidence and risk factors associated with dnDSA and compare outcomes between recipients with transient (or isolated) vs persistent dnDSA after transplantation.

METHODS

A single-center review of all lung transplants from 1/2009-7/2013. DSAs were tested eight times in the first year and every 4 months thereafter. Outcomes examined included acute rejection and graft failure.

RESULTS

Median follow-up was 18 months (range: 1-61 months), and 24.6% of 333 first-time lung-only transplant recipients developed a dnDSA. Ethnicity, HLA-DQ mismatches, post-transplantation platelet transfusion and Lung Allocation Score >60 were associated with dnDSA (P<.05). Overall graft survival was worse for dnDSA-positive vs negative recipients (P=.025). Of 323 recipients with 1-year follow-up, 72 (22.2%) developed dnDSA, and in 25 (34.7%), the dnDSA was transient and cleared. Recipients with transient dnDSA were less likely to develop acute rejection than those with persistent dnDSA (P=.007).

CONCLUSIONS

Early post-lung transplantation, dnDSA occurred in 1/4 of recipients, was associated with peri-transplant risk factors and resulted in decreased survival. Spontaneous clearance of dnDSA, seen in one-third of recipients, was associated with a lower risk of acute rejection.

Authors+Show Affiliations

Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.Department of Medicine, Houston Methodist Hospital, Houston, TX, USA.Department of Solid Organ Transplant Clinical Pharmacy, University of Kansas Medical Hospital, Kansas City, KS, USA.Department of Medicine, Houston Methodist Hospital, Houston, TX, USA.Department of Pulmonary and Critical Care, Memorial Hermann Hospital, Houston, TX, USA.Forensic Research & Analysis, Portland, OR, USA.Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA.Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA.Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.Department of Systems Medicine and Bioengineering, Houston Methodist Hospital, Houston, TX, USA.Department of Systems Medicine and Bioengineering, Houston Methodist Hospital, Houston, TX, USA.Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.Houston Methodist Lung Center, Houston, TX, USA.Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA.Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28658512

Citation

Islam, Ana K., et al. "Early Clearance Vs Persistence of De Novo Donor-specific Antibodies Following Lung Transplantation." Clinical Transplantation, vol. 31, no. 8, 2017.
Islam AK, Sinha N, DeVos JM, et al. Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation. Clin Transplant. 2017;31(8).
Islam, A. K., Sinha, N., DeVos, J. M., Kaleekal, T. S., Jyothula, S. S., Teeter, L. D., Nguyen, D. T. M., Eagar, T. N., Moore, L. W., Puppala, M., Wong, S. T. C., Knight, R. J., Frost, A. E., Graviss, E. A., & Osama Gaber, A. (2017). Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation. Clinical Transplantation, 31(8). https://doi.org/10.1111/ctr.13028
Islam AK, et al. Early Clearance Vs Persistence of De Novo Donor-specific Antibodies Following Lung Transplantation. Clin Transplant. 2017;31(8) PubMed PMID: 28658512.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation. AU - Islam,Ana K, AU - Sinha,Neeraj, AU - DeVos,Jennifer M, AU - Kaleekal,Thomas S, AU - Jyothula,Soma S, AU - Teeter,Larry D, AU - Nguyen,Duc T M, AU - Eagar,Todd N, AU - Moore,Linda W, AU - Puppala,Mamta, AU - Wong,Stephen T C, AU - Knight,Richard J, AU - Frost,Adaani E, AU - Graviss,Edward A, AU - Osama Gaber,A, Y1 - 2017/07/07/ PY - 2017/04/24/accepted PY - 2017/6/29/pubmed PY - 2018/5/23/medline PY - 2017/6/29/entrez KW - DSA KW - HLA antibodies KW - de novo KW - donor-specific antibody KW - graft failure KW - isolated KW - lung transplantation KW - persistent KW - rejection JF - Clinical transplantation JO - Clin Transplant VL - 31 IS - 8 N2 - BACKGROUND: The natural history of de novo donor-specific antibodies (dnDSA) after lung transplantation is not well-described. We sought to determine the incidence and risk factors associated with dnDSA and compare outcomes between recipients with transient (or isolated) vs persistent dnDSA after transplantation. METHODS: A single-center review of all lung transplants from 1/2009-7/2013. DSAs were tested eight times in the first year and every 4 months thereafter. Outcomes examined included acute rejection and graft failure. RESULTS: Median follow-up was 18 months (range: 1-61 months), and 24.6% of 333 first-time lung-only transplant recipients developed a dnDSA. Ethnicity, HLA-DQ mismatches, post-transplantation platelet transfusion and Lung Allocation Score >60 were associated with dnDSA (P<.05). Overall graft survival was worse for dnDSA-positive vs negative recipients (P=.025). Of 323 recipients with 1-year follow-up, 72 (22.2%) developed dnDSA, and in 25 (34.7%), the dnDSA was transient and cleared. Recipients with transient dnDSA were less likely to develop acute rejection than those with persistent dnDSA (P=.007). CONCLUSIONS: Early post-lung transplantation, dnDSA occurred in 1/4 of recipients, was associated with peri-transplant risk factors and resulted in decreased survival. Spontaneous clearance of dnDSA, seen in one-third of recipients, was associated with a lower risk of acute rejection. SN - 1399-0012 UR - https://www.unboundmedicine.com/medline/citation/28658512/Early_clearance_vs_persistence_of_de_novo_donor_specific_antibodies_following_lung_transplantation_ L2 - https://doi.org/10.1111/ctr.13028 DB - PRIME DP - Unbound Medicine ER -