| Affiliation: | 1. Pulmonary and Critical Care, Washington University School of Medicine, St. Louis, MO, USA;2. Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA;3. Pulmonary Medicine, Cleveland Clinic, Cleveland, OH, USA;4. Baylor University Medical Center, Dallas, TX, USA;5. Pulmonary and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA;6. Pulmonary and Critical Care, University of Texas Health Science Center, San Antonio, TX, USA;7. Pathology and Laboratory Medicine, Children’s Hospital, Oakland, CA, USA;8. Pulmonary and Critical Care, Stanford University School of Medicine, Stanford, CA, USA;9. Biostatistics, Washington University School of Medicine, St. Louis, MO, USA;10. Pulmonary and Critical Care, University of California, San Francisco, CA, USA;11. Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA;12. Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA;13. Pathology, Stanford University School of Medicine, Stanford, CA, USA |
| Abstract: | Donor‐specific antibodies (DSA) to mismatched human leukocyte antigens (HLA) are associated with worse outcomes after lung transplantation. To determine the incidence and characteristics of DSA early after lung transplantation, we conducted a prospective multicenter observational study that used standardized treatment and testing protocols. Among 119 transplant recipients, 43 (36%) developed DSA: 6 (14%) developed DSA only to class I HLA, 23 (53%) developed DSA only to class II HLA, and 14 (33%) developed DSA to both class I and class II HLA. The median DSA mean fluorescence intensity (MFI) was 3197. We identified a significant association between the Lung Allocation Score and the development of DSA (HR = 1.02, 95% CI: 1.001‐1.03, P = .047) and a significant association between DSA with an MFI ≥ 3000 and acute cellular rejection (ACR) grade ≥ A2 (HR = 2.11, 95% CI: 1.04‐4.27, P = .039). However, we did not detect an association between DSA and survival. We conclude that DSA occur frequently early after lung transplantation, and most target class II HLA. DSA with an MFI ≥ 3000 have a significant association with ACR. Extended follow‐up is necessary to determine the impact of DSA on other important outcomes. |
