Early donor-specific antibodies in lung transplantation: risk factors and impact on survival.

Abstract

BACKGROUND:

The impact of early donor-specific anti-HLA antibodies (DSA) on patient and graft survival after lung transplantation remains controversial. In this study we analyzed risk factors for DSA that developed before initial hospital discharge after lung transplantation (early DSA) and compared mid-term outcomes in patients with or without DSA.

METHODS:

Between January 2009 and August 2013, 546 patients underwent lung transplantation at our institution. One hundred (18%) patients developed early DSA (Group A) and 446 (82%) patients (Group B) did not. Patient records were retrospectively reviewed.

RESULTS:

Retransplantation (odds ratio [OR] = 2.7, 95% confidence interval [CI] 1.1 to 6.5, p = 0.03), pre-operative HLA antibodies (OR = 2.1, 95% CI 1.2 to 3.4, p = 0.003) and primary graft dysfunction (PGD) score Grade 2 or 3 at 48 hours (OR = 2.6, 95% CI 1.5 to 4.6, p = 0.001) were associated with early DSA development. Overall, 1- and 3-year survival in Group A and B patients was 79 ± 4% vs 88 ± 2% and 57 ± 8% vs 74 ± 3%, respectively (p = 0.019). Eleven Group A (11%) and 32 Group B (7%) patients died before hospital discharge (p = 0.34). Among patients surviving beyond discharge, 1- and 3-year survival in Group A and B patients was 89 ± 4% vs 95 ± 1% and 65 ± 8% vs 80 ± 3% in Group A and B patients, respectively (p = 0.04). Multivariate analysis identified early anti-HLA Class II DSA (OR = 1.9, 95% CI 1.0 to 3.4, p = 0.04) as an independent risk factor for post-discharge mortality but not for in-hospital mortality.

CONCLUSIONS:

Pre-operative HLA antibodies, retransplantation or post-operative PGD increase the risk of developing early DSA, which were independently associated with an increased risk for mortality.

• Authors: Fabio Ius, Wiebke Sommer, Igor Tudorache, Christian Kühn, Murat Avsar, Thierry Siemeni, Jawad Salman, Michael Hallensleben, Daniela Kieneke, Mark Greer, Jens Gottlieb, Axel Haverich, Gregor Warnecke
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 33 Issue 12 Pg. 1255-63 (Dec 2014) ISSN: 1557-3117 [Electronic] United States
• PMID: 25070908 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antibodies, Anti-Idiotypic
• HLA Antigens

Topics

• Adult
• Antibodies, Anti-Idiotypic (immunology)
• Female
• Graft Rejection (epidemiology, immunology, mortality)
• HLA Antigens (immunology)
• Humans
• Lung (immunology)
• Lung Transplantation (mortality)
• Male
• Middle Aged
• Multivariate Analysis
• Retrospective Studies
• Risk Factors
• Survival Rate
• Tissue Donors
• Treatment Outcome