De Novo DSA is associated with increased risk of Bronchiolitis Obliterans Syndrome (BOS) and lung allograft loss, however the characteristics of De Novo DSA that develops after lung retransplant with repeat mismatches is unclear. We investigate the effect of repeat HLA mismatches on the development of DSA following repeat lung grafts.

Our study included all individuals who received a second lung transplant at the Cleveland Clinic (n=15) and previous lung transplant at either the Cleveland Clinic (n=10) or another transplant center (n=5). We examined DSA, by single antigen Luminex beads to mismatched HLA antigens of the donor.

Results: Distribution of positive T cell flow crossmatch to the 2nd donor by pre-Tx DSA, mean number of mismatches against the 1st, 2nd donors and repeat MM are shown in table 1. Characteristics of De novo DSA is shown in Table 2

Of the fifteen individuals whom were included in this study, none developed DSA to a repeat HLA mismatch. Twelve of the fifteen recipients had repeat HLA mismatches, while every recipient had at least one HLA mismatch to each donor (Table 2). Of the twelve that had repeat HLA mismatches, five individuals developed DSA to the first donor only and two developed DSA to the second donor only; six individuals in total developed DSA at some point post-transplant (Table 1). Three individuals developed DSA after the second transplant, with one individual developing DSA within the first month post second transplant.

Two individuals had a positive T cell crossmatch to the second donor. However, neither of these patients developed DSA after the second tranaplant.

Based on the limited number of repeat lung transplants that our institute has performed, it appears that repeat HLA mismatches are not associated with increased risk of development of de novo DSA to these antigens. These results are clinically relevant to donor selection criteria for lung retransplants and warrant further investigation in a larger cohort.

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