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Persistence of de novo donor-specific HLA-antibodies after lung transplantation: a potential marker of decreased patient survival

The impact of de novo donor-specific anti-HLA-antibodies (donor-specific antibody [DSA]) on outcomes in lung transplantation is still a matter of debate. We hypothesize that differentiating DSA by persistent and transient appearance may offer an additional risk assessment. The clinical relevance of...

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Main Authors: Schmitzer, Magdalena (Author) , Winter, Hauke (Author) , Kneidinger, N. (Author) , Meimarakis, G. (Author) , Dick, A. (Author) , Schramm, R. (Author) , Klotz, Laura Valentina (Author) , Preissler, G. (Author) , Strobl, N. (Author) , Dossow, V. von (Author) , Schneider, C. (Author) , Weig, T. (Author) , Hatz, R. (Author) , Kauke, T. (Author)
Format: Article (Journal)
Language:English
Published: 2018
In: HLA
Year: 2018, Volume: 92, Issue: 1, Pages: 24-32
ISSN:2059-2310
DOI:10.1111/tan.13306
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1111/tan.13306
Verlag, lizenzpflichtig, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1111/tan.13306
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Author Notes:M. Schmitzer, H. Winter, N. Kneidinger, G. Meimarakis, A. Dick, R. Schramm, L. V. Klotz, G. Preissler, N. Strobl, V. von Dossow, C. Schneider, T. Weig, R. Hatz, T. Kauke
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Summary:The impact of de novo donor-specific anti-HLA-antibodies (donor-specific antibody [DSA]) on outcomes in lung transplantation is still a matter of debate. We hypothesize that differentiating DSA by persistent and transient appearance may offer an additional risk assessment. The clinical relevance of HLA-antibodies was investigated prospectively in 72 recipients with a median follow-up period of 21 months. The presence of HLA-antibodies was analysed by a single antigen bead assay before and after (3 weeks, 3, 6, 12 and 18 months) transplantation. In 23 patients (32%), de novo DSAs were detected. In 10 of these patients (44%), DSA persisted throughout the follow-up period, whereas 13 of these patients (56%) had transient DSA. There was a trend towards lower 1-year-survival in DSA-positive compared with DSA-negative patients (83% vs 94%; P = 0.199). Remarkably, patients with persistent DSA had significantly reduced survival (1-year survival 60%) compared with both patients without DSA and those with transient DSA (P = 0.005). Persistent DSA represented as an independent prognostic factor for reduced overall survival in multivariate analysis (HR 8.3, 95% CI 1.8-37.0; P = 0.006). Persistence of DSA during the first year after transplantation seems to be more harmful for lung allograft function than transiently detected DSA at an early stage.
Item Description:Gesehen am 06.04.2020
Physical Description:Online Resource
ISSN:2059-2310
DOI:10.1111/tan.13306

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