RT Journal Article
SR Electronic
T1 Donor-specific and -nonspecific HLA antibodies and outcome post lung transplantation
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1701248
DO 10.1183/13993003.01248-2017
VO 50
IS 5
A1 Stijn E. Verleden
A1 Bart M. Vanaudenaerde
A1 Marie-Paul Emonds
A1 Dirk E. Van Raemdonck
A1 Arne P. Neyrinck
A1 Geert M. Verleden
A1 Robin Vos
YR 2017
UL http://erj.ersjournals.com/content/50/5/1701248.abstract
AB Donor-specific antibodies (DSAs) against human leukocyte antigen (HLA) are associated with chronic lung allograft dysfunction (CLAD) and mortality post lung transplantation, but data concerning prevalence, time of onset, persistence and effects on long-term outcome remain scarce.We assessed the association between HLA antibodies and CLAD-free and graft survival in a cohort of 362 patients. We stratified our analysis according to DSA status, persistence of antibodies and timing of antibodies (pre-transplant, early or late post-transplant).Within our cohort, 61 (17%) patients developed DSAs (mostly against HLA-DQ), which was associated with worse CLAD-free and graft survival (p<0.0001 and p=0.059, respectively). Persistent (hazard ratio (HR) 3.386, 95% CI 1.928–5.948; p<0.0001) as well as transient (HR 2.998, 95% CI 1.406–6.393; p=0.0045) DSAs were associated with shorter CLAD-free survival compared with patients without DSAs. Persistent DSAs (HR 3.071, 95% CI 1.632–5.778; p=0.0005) but not transient DSAs were negatively associated with graft survival compared with patients without DSAs, likely due to the higher incidence of restrictive CLAD. HLA non-DSAs and pre-transplant HLA antibodies had no effect on post-transplant outcome.We demonstrated an important difference in prognosis between persistent and transient DSAs. Moreover, the observed association between DSAs and restrictive CLAD suggests an overlap between antibody-mediated rejection and restrictive CLAD that needs further investigation.Persistent donor-specific antibodies are associated with a higher incidence of rCLAD and mortality http://ow.ly/LD5730eFrgl