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

doi:10.1111/ctr.13028

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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21 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 language	English (US)
Journal	Clinical Transplantation
DOIs	https://doi.org/10.1111/ctr.13028
State	E-pub ahead of print - Jun 28 2017

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Journal Article

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10.1111/ctr.13028

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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. Advance online publication. https://doi.org/10.1111/ctr.13028

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title = "Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation",

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.",

keywords = "Journal Article",

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

note = "{\textcopyright} 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.",

year = "2017",

month = jun,

day = "28",

doi = "10.1111/ctr.13028",

language = "English (US)",

journal = "Clinical Transplantation",

issn = "0902-0063",

publisher = "Wiley",

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TY - JOUR

T1 - Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation

AU - Islam, Ana K

AU - Sinha, Neeraj

AU - DeVos, Jennifer M

AU - Kaleekal, Thomas S

AU - Jyothula, Soma S

AU - Teeter, Larry D.

AU - Nguyen, Duc T M

AU - Eagar, Todd N

AU - Moore, Linda W

AU - Puppala, Mamta

AU - Wong, Stephen T C

AU - Knight, Richard J

AU - Frost, Adaani E

AU - Graviss, Edward A

AU - Osama Gaber, A

PY - 2017/6/28

Y1 - 2017/6/28

N2 - 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.

AB - 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.

KW - Journal Article

U2 - 10.1111/ctr.13028

DO - 10.1111/ctr.13028

M3 - Article

C2 - 28658512

SN - 0902-0063

JO - Clinical Transplantation

JF - Clinical Transplantation

ER -

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

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