Clinical transplantation · 2025
Long-Term Chronic Lung Allograft Dysfunction-Free Survival Following Lung Transplant in the Presence of Donor-Specific Antibodies.
СтатьяНазвание и аннотация: Перевод в очереди
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Grobman Benjamin, Courtwright Andrew M, Yeung Melissa, Jacob Selvin, Lee Stefi, Sheikh Adil, Keshk Mohamed, Hackman Amy, Coppolino Anthony, Dunning John, Sharma Nirmal, Goldberg Hilary J
Аннотация
BACKGROUND: Highly sensitized patients with advanced lung disease, who are more often Black and Hispanic women, are at increased risk for waitlist death. In 2012, we implemented a protocol to cross any pre-transplant donor-specific antibody (DSA), so long as a prospective complement-dependent cytotoxicity (CDC) crossmatch was negative. We report long-term outcomes, including overall survival and chronic lung allograft dysfunction (CLAD)-free survival.
METHODS: This was a single-institution retrospective cohort study of lung transplant recipients between October 1, 2012-December 31, 2022. We compared overall retransplant-free survival and CLAD-free survival between recipients with and without pre-formed DSA. Secondary outcomes included freedom from acute cellular rejection (ACR) and antibody-mediated rejection (AMR).
RESULTS: The study cohort included 427 recipients with a median duration of follow-up of 4.3 years (IQR = 2.1-6.9). Thirty-three (7.7%) recipients had pre-transplant DSA with a peak historical mean fluorescence intensity (MFI) of 4200 (IQR = 3000-6600, total range 2100-23 000). The median number of DSA per patient was 1 (IQR = 1-2, total range 1-8). There was no difference in adjusted overall survival between recipients with and without pre-formed DSA (HR = 1.39, 95% CI = 0.82-2.36, p = 0.22) or adjusted CLAD-free survival between recipients with and without pre-formed DSA (HR = 1.07, 95% CI = 0.65-1.75, p = 0.79). Recipients with pre-formed DSA did not have increased adjusted hazard of ACR (HR = 0.71, 95% CI = 0.29-1.75, p = 0.45) but did have increased adjusted hazard of AMR (HR = 5.02, 95% CI = 2.11-11.95, p < 0.001).
CONCLUSIONS: In this moderately-sized cohort, a protocol of accepting donor offers for lung transplant candidates with pre-formed DSA but negative CDC crossmatch was not associated with worse overall or CLAD-free survival, within the limitations of the sample size.
METHODS: This was a single-institution retrospective cohort study of lung transplant recipients between October 1, 2012-December 31, 2022. We compared overall retransplant-free survival and CLAD-free survival between recipients with and without pre-formed DSA. Secondary outcomes included freedom from acute cellular rejection (ACR) and antibody-mediated rejection (AMR).
RESULTS: The study cohort included 427 recipients with a median duration of follow-up of 4.3 years (IQR = 2.1-6.9). Thirty-three (7.7%) recipients had pre-transplant DSA with a peak historical mean fluorescence intensity (MFI) of 4200 (IQR = 3000-6600, total range 2100-23 000). The median number of DSA per patient was 1 (IQR = 1-2, total range 1-8). There was no difference in adjusted overall survival between recipients with and without pre-formed DSA (HR = 1.39, 95% CI = 0.82-2.36, p = 0.22) or adjusted CLAD-free survival between recipients with and without pre-formed DSA (HR = 1.07, 95% CI = 0.65-1.75, p = 0.79). Recipients with pre-formed DSA did not have increased adjusted hazard of ACR (HR = 0.71, 95% CI = 0.29-1.75, p = 0.45) but did have increased adjusted hazard of AMR (HR = 5.02, 95% CI = 2.11-11.95, p < 0.001).
CONCLUSIONS: In this moderately-sized cohort, a protocol of accepting donor offers for lung transplant candidates with pre-formed DSA but negative CDC crossmatch was not associated with worse overall or CLAD-free survival, within the limitations of the sample size.