De Novo Donor-Specific Antibody Development with Mycophenolate versus Azathioprine in Lung Transplant Recipients
1UNC Health, Chapel Hill, NC, 2University of Michigan, Ann Arbor, MI, 3University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
Meeting: 2022 American Transplant Congress
Abstract number: 339
Keywords: HLA antibodies, IMPDH Inhibitor, Lung transplantation, Rejection
Topic: Clinical Science » Lung » 64 - Lung: All Topics
Session Information
Session Name: Early and Late Outcomes in Lung Transplantation
Session Type: Rapid Fire Oral Abstract
Date: Monday, June 6, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 6:30pm-6:40pm
Location: Hynes Room 210
*Purpose: The effect of mycophenolate mofetil (MMF) or azathioprine (AZA) immunosuppression (ISN) regimens on de novo donor specific antibody (DSA) formation in lung transplant recipients (LTR) is unknown. We compared LTR on MMF to those converted to AZA early post-transplant for incidence and durability of DSA formation.
*Methods: A single-center analysis of adult LTR from 5/2014 – 10/2020 receiving basiliximab induction and maintenance tacrolimus, MMF, and prednisone was conducted. LTR converted to cyclosporine and positive cross match were excluded. LTR switched to AZA within 90 days of transplant were compared to LTR maintained on MMF. All LTR with a DSA (MFI >1000 = positive) received intravenous immune globulin (IVIG) 0.5g/kg monthly until 3 negative DSA screens. DSA and patient outcomes were assessed within 1 year post-transplant.
*Results: Sixty-five LTR were included; 17 were switched from MMF to AZA for gastrointestinal intolerance. LTR converted to AZA were more commonly female with longer index LOS. Significantly more LTR converted to AZA developed DSAs within the first year (58.8% vs 27.1%, p=0.019), however by 1 year most DSAs resolved and no difference was seen in DSA screen at 12 months post-transplant (11.8% vs. 10.4%, p=0.878). No antibody mediated rejection occurred; no differences in cellular rejection were observed (23.5% vs. 28.9%, p=0.569). ISN was similar between the AZA and MMF groups (Table 3). No differences were seen in time to DSA, time to durable negative DSA panel, dominant DSA (all Class II), median peak MFI of DSAs, IVIG doses administered, or patient survival at 1 year (100% vs. 93.8%, p=0.291).
*Conclusions: While more LTR converted from MMF to AZA developed DSAs, these were transient and resolved similarly to those maintained on MMF following IVIG therapy. Female LTR and those with prolonged LOS were more likely to be converted to AZA. No other clinical differences were observed. Given the small sample size and retrospective design, further research is needed to evaluate the impact of AZA or MMF on DSA development in LTR.
To cite this abstract in AMA style:
Prom A, Walter K, Gomez K, Doligalski C, Lobo L, Evans R. De Novo Donor-Specific Antibody Development with Mycophenolate versus Azathioprine in Lung Transplant Recipients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/de-novo-donor-specific-antibody-development-with-mycophenolate-versus-azathioprine-in-lung-transplant-recipients/. Accessed May 6, 2025.« Back to 2022 American Transplant Congress