Abstract
Lung transplantation (LT) is a treatment for irreversible chronic respiratory failure. The survival has increased but the morbidity of LT remains linked to complications, such as acute rejection (AR). The gold standard for diagnosis is based on lung biopsy. The only non-invasive test available is the DSA determination. Recently, donor-derived cell-free DNA (dd-cfDNA) is described as correlating with AR in LT recipients.
The main goal of this monocentric and prospective study is to identify non-invasive biomarkers of AR in first trimester after LT.
Patients were sampled the day of LT, 15 days (D15), 1 (M1), 3, 6, 12 months after. The HLA antibodies were detected by Luminex (Lifescreen SA) and DSA were determined with donor HLA typing by NGS (NGmix, EFS). The dd-cfDNA study was made by NGS with the AlloSeq cfDNA kit (CareDx). Based on clinical data and biopsy at M1, the INF infection, AR rejection and stable groups were formed.
The kinetic of dd-cfDNA for stable lung recipients reached the baseline (<1% cut-off) at about M1 to M3 after LT. At D15, dd-cfDNA median levels in stable patients were higher for bi- than for single-lung transplantation (p=0.005), and all patients still had a dd-cfDNA level>1%. At M1, the median dd-cfDNA levels for AR or INF groups were elevated compared with the stable group (p=0.0182, p<0.0001, respectively). Interesting, the association of dd-cfDNA with DSA increased the statistical significance for the AR group.
These results suggest that dd-cfDNA can be useful to detect early clinical complications after LT and that this relevance is increased in combination with other non-invasive markers such as DSA detection. These results need to be confirmed by a multicenter cohort.
Footnotes
Cite this article as Eur Respir J 2022; 60: Suppl. 66, 4641.
This article was presented at the 2022 ERS International Congress, in session “-”.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
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