Session Time: 4:00pm-5:30pm
Presentation Time: 5:12pm-5:24pm
Location: Room 115-C
HLA donor specific antibodies (DSA) have been associated with poor allograft survival following adult solid organ transplantation (Tx). However, there is little evidence implicating post-Tx DSA in the development of bronchiolitis obliterans syndrome (BOS) in pediatric lung Tx.
A retrospective evaluation was performed on 73 pediatric lung Tx recipients who underwent lung transplantation at our institution between April 2009 and March 2014. We excluded Re-Tx lung recipients and those patients in whom there was no data. The cohort included 48 females and 25 males with a mean age of 11 ± 6 years (range 1-21). Each patient had pre and post- Tx testing for the presence of HLA antibodies (Abs), DSAs, development of post-Tx BOS and graft survival. All donor-recipient Tx pairs were ABO compatible.
The one, two and three year graft survivals were 92%, 88% and 85% respectively for these 73 lung allograft recipients. Sixty-three of 73 (86%) pre-Tx HLA class I (c l) and HLA class II (c ll) PRAs were 0% and 0% respectively while 10/73 (14%) of the pre-Tx PRAs were HLA c l 10 ± 9% and HLA c II 15 ± 11%. No recipient presented with pre-Tx DSA. However, post-Tx 40/73 (55%) of the recipients displayed HLA Abs of which 19/73 (26%) were de novo DSAs. There were 11/73 (14%) of the recipients who developed post-Tx BOS and 8/11 (73%) of the BOS recipients presented with DSA while only 9/62 (15%) of non-BOS recipients presented with DSA, p ˂ 0.02. All eight DSA positive sera from BOS diagnosed recipients presented with anti-HLA DQ Abs. In addition, four of the eight DSA positive sera from BOS recipients tested C1q positive while four patient sera tested C1q negative.
These data suggest that few pre and post-Tx pediatric lung recipients are highly sensitized to HLA. However, there is an association between development of de novo post-Tx donor specific HLA Abs (anti-HLA DQ) and the development of post-Tx BOS in these pediatric lung Tx recipients. Moreover, preliminary data suggest that both complement fixing and non-complement fixing Abs may be present. These data suggest the benefit of timely post-Tx immune evaluation of these pediatric patients to better care for them.
To cite this abstract in AMA style:Melicoff E, Maddox J, Ebenbichler M, Heinle J, McKenzie D, Jindra P, Mallory G, Kerman R. Post Transplant De Novo Donor Specific Antibodies Correlate With the Development of Bronchiolitis Obliterans Syndrome Following Pediatric Lung Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/post-transplant-de-novo-donor-specific-antibodies-correlate-with-the-development-of-bronchiolitis-obliterans-syndrome-following-pediatric-lung-transplantation/. Accessed September 22, 2019.
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