Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation

Ana K. Islam, Neeraj Sinha, Jennifer M. DeVos, Thomas S. Kaleekal, Soma S. Jyothula, Larry D. Teeter, Duc T.M. Nguyen, Todd N. Eagar, Linda W. Moore, Mamta Puppala, Stephen T.C. Wong, Richard J. Knight, Adaani E. Frost, Edward A. Graviss, A. Osama Gaber

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10 Scopus citations

Abstract

Background: 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. Methods: 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. Results: 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. Recipients with transient dnDSA were less likely to develop acute rejection than those with persistent dnDSA (P=.007). Conclusions: Early post-lung transplantation, dnDSA occurred in 1/4 of recipients, was associated with peri-transplant risk factors and resulted in decreased survival. Spontaneous clearance of dnDSA, seen in one-third of recipients, was associated with a lower risk of acute rejection.

Original languageEnglish (US)
Article numbere13028
JournalClinical Transplantation
Volume31
Issue number8
DOIs
StatePublished - Aug 1 2017

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Keywords

  • de novo
  • donor-specific antibody
  • DSA
  • graft failure
  • HLA antibodies
  • isolated
  • lung transplantation
  • persistent
  • rejection

ASJC Scopus subject areas

  • Transplantation

Cite this

Islam, A. K., Sinha, N., DeVos, J. M., Kaleekal, T. S., Jyothula, S. S., Teeter, L. D., Nguyen, D. T. M., Eagar, T. N., Moore, L. W., Puppala, M., Wong, S. T. C., Knight, R. J., Frost, A. E., Graviss, E. A., & Osama Gaber, A. (2017). Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation. Clinical Transplantation, 31(8), [e13028]. https://doi.org/10.1111/ctr.13028