The presence of DSA after lung transplantation has been associated with adverse outcomes, but the utility of long-term routine screening remains controversial. For lung recipients whose first post-transplant test for DSA was performed greater than 1 year after transplant, we examined the incidence and characteristics of DSAs.
Lung transplant recipients (n=60) from a single center with their first DSA sample collected greater than 1 year after transplant were studied. Specimens were collected at bronchoscopy procedures including surveillance at 12, 18, and 24 months post-transplant and procedures performed for clinical indication. HLA antibodies were detected using single antigen testing (LABScreen®, One Lambda) and the DSA with highest mean fluorescence intensity (MFI) was defined as the immunodominant DSA (iDSA).
Amongst recipients who had samples tested 12-24 months post-transplant (n=21), 16 (76%) did not have any iDSA >1,000 MFI and 5 (24%) had relatively weak iDSA (median 1,543 MFI, range 1,239-2,302 MFI). Patients (n=38) tested >2 yr post-transplant (median 4.78, range 2.2-14.1 yr) had similar incidence of iDSA >1,000 MFI (23%), but antibody levels were higher (median 7,283, range 1,419-18,170 MFI). Four of these patients had iDSA >10,000 MFI (first detected 2.5, 3.7, 6.6, and 9.2 yr post-transplant) and all of these iDSA were against HLA-DQ. For this small group, 1 died, 2 have poor graft function, and 1 remains stable. An additional 10 patients tested >2 yr post-transplant (23%) had evidence for very weak iDSA (median 613, range 224-987 MFI).
Conclusion: Nearly one quarter of lung transplant recipients whose first test for DSA is performed >1 year after lung transplant have DSA >1000 MFI. DSA levels tend to be higher in the patients who have samples obtained >2 yr post-transplant when specimens are obtained for clinical indication rather than at the time of routine surveillance. In this patient sample, high levels of HLA-DQ DSA (>10,000) appear to be associated with poor clinical outcomes.
To cite this abstract in AMA style:Baxter-Lowe L, Singer J, Hays S, Kukreja J, Golden J, Leard L. Late after Lung Transplantation Many Patients Have Donor-Specific HLA Antibodies (DSA) and High DSA Levels Appear To Be Associated with Poor Outcomes [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/late-after-lung-transplantation-many-patients-have-donor-specific-hla-antibodies-dsa-and-high-dsa-levels-appear-to-be-associated-with-poor-outcomes/. Accessed January 16, 2018.
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