Anti-human leukocyte antigen antibodies and preemptive antibody-directed therapy after lung transplantation

Distributions are shown of mean fluorescence intensity (MFI) and the ratio of donor-specific anti-human leukocyte antigen antibody (DSA) MFI to positive control MFI for recipients who developed DSA. Boxes extend from the 25th to the 75th percentiles, the whiskers extend to the largest and smallest values within 1.5 box lengths, and the line within the boxes represents the median. The solid circles represent outlier cases between 1.5 and 3 box lengths from the upper edge of the boxes.

Flowchart shows the study, treatments, and possible outcomes. DSA, donor-specific anti-human leukocyte antigen antibody; IVIG, intravenous immunoglobulin.

(A) Freedom from bronchiolitis obliterans syndrome (BOS) was not significantly different between recipients who developed donor-specific anti-human leukocyte antigen antibodies (DSA) and were treated with intravenous immunoglobulin (IVIG) and rituximab and those who were treated with IVIG alone. (B) There was no significant difference in freedom from BOS between those who developed DSA to class I antigens, class II antigens, or both class I and class II antigens. (C) BOS was more likely to develop in recipients who had persistent DSA than in those who cleared the DSA.

(A) Survival was significantly worse in recipients who developed donor-specific anti-human leukocyte antigen antibody (DSA) and were treated with intravenous immunoglobulin (IVIG) alone than in those treated with IVIG and rituximab. (B) There was no significant survival difference between those who developed DSA to class I antigens, class II antigens, or both class I and class II antigens. (C) Survival was significantly worse in recipients who had persistent DSA than in those who cleared the DSA.

Bronchiolitis obliterans syndrome (BOS) was the most frequent cause of death, followed by pneumonia. AAMR, acute antibody-mediated rejection; DSA, donor-specific anti-human leukocyte antigen antibody; PGD, primary graft dysfunction.