Purpose: To reduce waitlist time for sensitized lung transplant recipients (LTR), our center used peri-operative desensitization for LTR with a positive virtual crossmatch (P-VXM). We aimed to examine immunosuppression, infection and survival in our desensitized P-VXM LTR compared to negative virtual crossmatch (N-VXM) LTR.

Methods: This was an IRB-approved, single-center retrospective study of LTR transplanted between 01/2015-05/2017. Multi-organ transplants or those with no virtual crossmatch available were excluded. Variables for analysis included induction agents, tacrolimus levels, mycophenolate mofetil daily doses, infections and patient survival.

Results: Seven LTR (20%) in the N-VXM group received induction, 6 of which received a lymphocyte depleting agent. Desensitization therapy for all P-VXM LTR included rabbit anti-thymocyte globulin (median total dose of 3 mg/kg, IQR 2.7-4.8), intravenous immunoglobulin G (median total dose of 1 g/kg, IQR 1-1) and plasmapheresis (3 sessions intra-op and a median of 4 sessions post-op, IQR 4-5) within 7 days of transplant. Maintenance immunosuppression appeared similar between groups, with no significant difference in tacrolimus trough levels (p=0.96). There were no significant differences in infections (Table 1) or patient survival (100% in the P-VXM group vs. 94% in the N-VXM group, p=0.26) at a median time to follow-up of 685 days (IQR 602-697) vs. 359 days (IQR 262-502), respectively; p= 0.008.

Conclusion: Our study has shown no differences in maintenance immunosuppressive regimens, infections and survival in P-VXM LTR who underwent desensitization when compared to N-VXM LTR, despite more use of lymphocyte depleting agents and plasmapheresis. Based off our single-center study, P-VXM LTR may be safely transplanted, although more studies are warranted.

CITATION INFORMATION: Hammad S., Ravichandran B., Kim J., KuKuruga D., Cipriano S., Kon Z. Evaluation of Immunosuppression and Infection after Desensitization in Lung Transplantation Am J Transplant. 2017;17 (suppl 3).

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