Background
Despite growing interest in donor-specific antibodies (DSAs) and antibody-mediated
rejection (AMR) in lung transplantation (LTx), no study evaluating the outcomes in
recipients with de novo DSAs (dnDSAs) in living-donor lobar LTx (LDLLT) exists. We
compared various characteristics of DSAs in LDLLT with those in cadaveric LTx (CLT)
based on prospectively collected data.
Methods
Between October 2009 and September 2019, 211 recipients underwent LTx (128 CLTs and
83 LDLLTs). We reviewed 108 CLTs and 74 LDLLTs to determine the characteristics and
clinical impact of dnDSAs. Eighteen data-deficient cases, 7 cases with preformed DSAs,
and 4 re-transplants were excluded.
Results
There were significant differences between CLT and LDLLT patients in age, primary
disease, ischemic time, and number of human leukocyte antigen mismatches per donor.
The dnDSA incidence in LDLLT (6.8%) was significantly lower than that in CLT (19.4%,
p = 0.02). The dnDSAs appeared later in LDLLT (mean 1,256 days) than in CLT (mean 196
days, p = 0.003). According to Cox models analyzed using dnDSA as a time-dependent covariate,
dnDSA positivity was significantly associated with a poor overall survival (OS; hazard
ratio [HR] 3.46, 95% confidence interval [CI] 1.59-7.57, p = 0.002) and poor CLAD-free survival in case of CLT (HR: 2.23, 95% CI: 1.08-4.63,
p = 0.003). However, no such significant associations were noted in case of LDLLT.
Conclusions
The dnDSA occurrence was significantly lower and later in LDLLT than in CLT. Furthermore,
dnDSA-positivity was significantly associated with worse OS and CLAD-free survival
after CLT but not after LDLLT.
Keywords
Abbreviations:
LTx (lung transplantation), LDLLT (living-donor lobar lung transplantation), CLAD (chronic lung allograft dysfunction), DSA (donor-specific antibody), AMR (antibody mediated rejection), dnDSA (de novo donor-specific antibody), CLT (cadaveric lung transplantation), ISHLT (International Society of Heart and Lung Transplantation), OS (overall survival), HR (hazard ratio), CI (confidence interval), HLA (human leukocyte antigen), BOS (bronchiolitis obliterans syndrome), RAS (restrictive allograft syndrome)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 29, 2021
Identification
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© 2021 International Society for Heart and Lung Transplantation. All rights reserved.
