Evaluation of current strategies for surveillance and management of donor-specific antibodies: Single-center study

Daniel Sullivan, Chul Ahn, Ang Gao, Chantale Lacelle, Fernando Torres, Srinivas Bollineni, Amit Banga, Jessica Mullins, Manish Mohanka, Steve Ring, Michael Wait, Matthias Peltz, Pavan Duddupudi, Dhiraj Surapaneni, Vaidehi Kaza

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background: Although the presence of donor-specific antibodies (DSA) is known to impact lung allograft, limited data exist regarding DSA management. Methods: We did a retrospective study at our center evaluating DSA management in adult lung transplant recipients undergoing lung transplantation between January 1, 2010 and June 30, 2014. Study follow-up was completed through October 2017. All recipients were stratified into 2 groups based on the presence or absence of DSA. Those with DSA were evaluated for the impact of treatment of DSA. The primary outcomes were postlung transplant survival and freedom from bronchiolitis obliterans syndrome (BOS), subset of chronic lung allograft dysfunction (CLAD). Simon-Makuch method was used to estimate overall survival and BOS-free survival to account for DSA as time-dependent covariate. Survival differences between the groups were analyzed using time-dependent Cox proportional hazards model. Results: Sixty-four percent of 194 total subjects developed post-lung transplant DSA. Overall survival was different with worse survival in the DSA positive group that never cleared DSA (P =.002). BOS-free survival was lower, but did not reach significance in this group. Response to treatment was poor, with only 12 of 47 (25.5%) who received treatment demonstrating clearance of DSA. Conclusions: Donor-specific antibodies prevalence is high after lung transplantation. Clearance of DSA correlated with improved outcomes. Current therapeutic strategies against DSA are relatively ineffective. Multicenter collaborative studies will be required to evaluate current treatment strategies and other innovative modalities.

Original languageEnglish (US)
Article numbere13285
JournalClinical Transplantation
Volume32
Issue number7
DOIs
StatePublished - Jul 1 2018

Keywords

  • chronic lung allograft dysfunction
  • donor-specific antibodies
  • lung transplantation
  • rejection
  • treatment of DSA

ASJC Scopus subject areas

  • Transplantation

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