Donor-specific antibody characteristics, including persistence and complement-binding capacity, increase risk for chronic lung allograft dysfunction
Section snippets
Methods
This observational cohort study was approved by the University of Pittsburgh Institutional Review Board and included adult LTRs transplanted between January 1, 2010 and September 1, 2016. Patients were excluded from analysis if they did not have pulmonary function testing or post-transplant DSA testing. If a patient received multiple lung transplants during the study period, only the first transplant was included for analysis. Clinical data, including patient demographics, laboratory results,
Results
A total of 640 LTRs were initially identified as transplanted in the study timeframe. Of these, 582 met inclusion criteria and were analyzed (Figure 1). The mean age of the cohort was 55.5 years, with the majority of the LTRs being Caucasian (n = 522, 89.7%) and male (n = 333, 57.2%). The median follow-up time was 35 months (interquartile range: 16–56 months). Interstitial lung disease was the most common indication for transplant (n = 206, 35.4%). Patients were grouped according to the
Discussion
Our findings in this large, single-center study demonstrate that DSA characteristics, including persistence, DQ specificity, and complement-binding capacity as determined by the C1q-SAB assay, are independent risk factors for the development of CLAD after lung transplantation. We found that all C1q+ DSAs were persistent and that the majority (94%) exhibited specificity toward the mismatched donor HLA-DQ.
We found that, overall, 42% of LTRs had DSAs and 21% had de novo DSAs; these values are
Disclosure statement
The authors have no conflicts of interest to disclose.
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2023, Journal of Heart and Lung TransplantationCitation Excerpt :Additionally, given that nearly all clinical AMR patients have acute abnormalities on chest imaging, specifically ground glass opacities, consideration can be given to incorporating chest imaging into AMR diagnostic criteria. Like prior studies, we showed that DSA positivity and clinical AMR is associated with poor outcomes 4,7,22-25; however, the risk of allograft failure and development of CLAD was similar between definite, probable, and possible clinical AMR patients. This finding, as well as the similar clinical characteristics between groups, validates possible AMR as a clinical AMR category with high prognostic significance.
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These authors have contributed equally to this work.