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Donor-specific antibodies are associated with antibody-mediated rejection, acute cellular rejection, bronchiolitis obliterans syndrome, and cystic fibrosis after lung transplantation
The Journal of Heart and Lung Transplantation, 2013
De novo donor-specific anti-HLA antibodies thirty days after lung transplantation are associated with a worse outcome
The Journal of Heart and Lung Transplantation, 2016
De-novo donor-specific anti-HLA antibodies 30 days after lung transplantation are associated with a worse outcome
The Journal of Heart and Lung Transplantation, 2016
P072 De novo anti-HLA-class II donor specific antibodies are associated with patient mortality after lung transplant failure
Human Immunology, 2016
Lung Transplantation in Patients with Pretransplantation Donor-Specific Antibodies Detected by Luminex Assay
Transplantation, 2013
Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation
Clinical transplantation, 2017
The natural history of de novo donor-specific antibodies (dnDSA) after lung transplantation is not well-described. We sought to determine the incidence and risk factors associated with dnDSA and compare outcomes between recipients with transient (or isolated) vs persistent dnDSA after transplantation. A single-center review of all lung transplants from 1/2009-7/2013. DSAs were tested eight times in the first year and every 4 months thereafter. Outcomes examined included acute rejection and graft failure. Median follow-up was 18 months (range: 1-61 months), and 24.6% of 333 first-time lung-only transplant recipients developed a dnDSA. Ethnicity, HLA-DQ mismatches, post-transplantation platelet transfusion and Lung Allocation Score >60 were associated with dnDSA (P<.05). Overall graft survival was worse for dnDSA-positive vs negative recipients (P=.025). Of 323 recipients with 1-year follow-up, 72 (22.2%) developed dnDSA, and in 25 (34.7%), the dnDSA was transient and cleared. R...
Lung intragraft donor-specific antibodies as a risk factor for graft loss
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 2016
The effect of donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) on graft survival is recognized in lung transplantation, but not all serum DSAs appear to be harmful. We wondered whether in situ DSA detection from graft biopsy specimens could help in identifying lung transplant recipients (LTRs) at higher risk for graft loss. Class I and II HLA antibody single-antigen flow bead assays were performed in 53 LTRs to identify immunoglobulin G DSA in biopsy specimen eluates and in sera and to evaluate C1q binding ability of DSA in sera. Intragraft DSAs (gDSAs) were correlated with serum DSAs (sDSAs), clinical and histologic data, and graft survival. Twenty-eight (52.8%) LTRs had sDSAs, 12 (22.6%) had C1q-positive sDSAs, and 11 (20.8%) had gDSAs. Fifty sDSAs were found, among which 15 (30%) were C1q-positive and 14 (28%) were found in biopsy specimen eluates. One DSA was detected in the biopsy specimen only. Serum mean fluorescence intensity and biopsy fragment size were ...
Intragraft donor-specific anti-HLA antibodies in phenotypes of chronic lung allograft dysfunction
European Respiratory Journal, 2019
IntroductionCirculating anti-human leukocyte antigen (HLA) serum donor-specific antibodies (sDSAs) increase the risk of chronic lung allograft dysfunction (CLAD) and mortality. Discrepancies between serological and pathological/clinical findings are common. Therefore, we aimed to assess the presence of tissue-bound graft DSAs (gDSAs) in CLAD explant tissue compared with sDSAs.MethodsTissue cores, obtained from explant lungs of unused donors (n=10) and patients with bronchiolitis obliterans syndrome (BOS; n=18) and restrictive allograft syndrome (RAS; n=18), were scanned with micro-computed tomography before elution of antibodies. Total IgG levels were measured via ELISA. Anti-HLA class I and II IgG gDSAs were identified using Luminex single antigen beads and compared with DSAs found in serum samples.ResultsOverall, mean fluorescence intensity was higher in RAS eluates compared with BOS and controls (p<0.0001). In BOS, two patients were sDSA+/gDSA+ and two patients were sDSA−/gDSA...
Early donor-specific antibodies in lung transplantation: Risk factors and impact on survival
The Journal of Heart and Lung Transplantation, 2014
Single lung transplantation in a patient with retrospective positive cross-match
Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery, 2015
Lung transplantation is a method useful in such non-malignant end-stage parenchymal and vascular diseases as: chronic obstructive pulmonary disease (COPD), idiopathic interstitial pulmonary fibrosis, cystic fibrosis, or primary pulmonary hypertension. The main aim of this procedure is to extend the patient's lifespan and quality of life. However, the availability of the operation is limited by organ access. In this paper we present the case of a 58-year-old female in the fourth stage of COPD, who was classified to have a single lung transplantation. Because of some technical problems it was decided to transplant a left donor lung in the right recipient lung locus. Positive cross match was demonstrated retrospectively, and we applied five courses of plasmapheresis. Human immunoglobulin and rituximab treatment were performed to decrease the impact of lymphocytotoxic antibodies. The patient survived 498 days after transplantation, 271 in the hospital.
Abstracts / Human Immunology 73 (2012) 49–167
182-P
LIVING SIMULTANEOUS DOUBLE LUNG TRANSPLANT RECIPIENT WITH POST-TRANSPLANT DQA DSA
TOWARDS ONE DONOR. Christine Yamniuk, Anne Halpin, Patricia Campbell, Luis Hidalgo. Laboratory
Medicine & Pathology, University of Alberta Hospital, Edmonton, AB, Canada.
Aim: This case study investigates a living simultaneous double lung transplant recipient with post-transplant DQA DSA towards one donor.
Ò
Methods: All post-transplant testing was performed by One Lambda (OLI) FlowPRA Screening (FPRA) Class
Ò
Ò
I and II, LABScreen Mixed (LSMIX) and LABScreen Single Antigen Class I/II (LSA1/2) beads. DQA1⁄ typings
Ò
were performed by OLI LABType SSO.
Results: A 33 year old female presented with cystic fibrosis and end stage lung disease and was evaluated
for lung transplant in 2000. She was negative by Class I ELISA. The patient was transplanted in Feb 2001 with
2 of 3 potential living donors; the patient’s father and a friend (Table 1). The patient did well post-operatively
and was not screened by our lab until 2007. FPRA and LSA were negative. In 2011 the patient was evaluated
for declining lung function. The FPRA was Class I 0% Class II 60% with significant architecture. LSA2 revealed
strong DQA1⁄04, 05 and 06. DQA typings on the recipient and donors were performed. DSA to DQA1⁄05 was
confirmed with donor 1 typing as homozygous DQA1⁄01, donor 2 as DQA1⁄01 DQA1⁄05 and the recipient
DQA1⁄01:03 DQA1⁄03. No Class I DSA were detected by LSA. FEV1 correlates with the DSA detected in July
2011. The patient was treated for AMR with thymoglobulin, rituximab and high dose IVIG. Follow up LSA testing in November 2011 and March 2012 reveals persistent antibody to DQA1⁄04, 05 and 06 however they do
not appear to be increasing in strength. The recipient currently has some compromised lung function and is
being closely monitored.
Conclusions: This is an interesting case of late AMR due to DQA DSA towards one of two simultaneous living donor lungs. The specificity of the DSA highlights the importance of class II mismatches in late AMR and
particularly DQA1 in cases where either DQA1⁄04, 05, or 06 are mismatched and all are absent in the
recipient.
Table 1
HLA Mismatches
Donor 1
Donor 2
Class I MM
Class II MM
A⁄01 B⁄37
A⁄03 B⁄07 B⁄58
DRB1⁄01 DRB1⁄03 (17) DQB1⁄05 DQA1⁄05
163
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