Department of Thoracic Surgery, Kyoto University Graduate school of Medicine, Kyoto, Japan.
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Interact Cardiovasc Thorac Surg. 2021 Apr 19;32(4):616-624. doi: 10.1093/icvts/ivaa311.
Few studies have evaluated the outcomes of lung transplantation (LTx) in recipients with preformed donor-specific antibodies (DSAs). This study investigated the postoperative changes in preformed DSAs based on prospectively collected data of DSAs, and the influences of preformed DSAs on postoperative outcomes among LTx recipients.
Between July 2010 and December 2019, 216 recipients underwent LTx (81 living-donor lobar lung transplants and 135 deceased-donor lung transplants). We reviewed 8 cases with preformed DSAs to determine postoperative changes in DSAs and compared postoperative outcomes between recipients with and without DSAs.
The preoperative mean fluorescence intensity of preformed DSAs ranged from 1141 to 14 695. Two recipients experienced antibody-mediated rejection within 2 weeks after LTx. DSAs disappeared in 7 recipients; however, 1 recipient experienced the relapse of DSAs and died from chronic lung allograft syndrome (CLAD), whereas 1 recipient had persisting DSAs within the study period and died from CLAD. Neither overall survival (OS) nor CLAD-free survival was significantly different between recipients with and without DSAs (P = 0.26 and P = 0.17, respectively). However, both OS and CLAD-free survival were significantly lower in recipients with DSAs against HLA class II than in those without these antibodies {5-year OS: 25.0% [95% confidence interval (CI): 0.9-66.5%] vs 72.1% (95% CI: 63.8-78.9%), P = 0.030 and 5-year CLAD-free survival: 26.7% (95% CI: 1.0-68.6%) vs 73.7% (95% CI: 66.5-79.5%), P = 0.002}.
Prognosis in recipients experiencing the relapse of preformed DSAs and those with persisting DSAs may be poor. The recipients with anti-HLA class II preformed DSAs had a significantly worse prognosis.
鲜有研究评估预先存在的供体特异性抗体（DSA）对肺移植（LTx）受者结局的影响。本研究基于预先收集的 DSA 数据，调查了 LTx 受者术后预先存在的 DSA 的变化，并探讨了预先存在的 DSA 对术后结局的影响。
2010 年 7 月至 2019 年 12 月，216 例患者接受了 LTx（81 例活体供体肺叶移植和 135 例尸体供体肺移植）。我们回顾了 8 例预先存在 DSA 的患者，以确定 DSA 术后的变化，并比较了 DSA 阳性和 DSA 阴性患者的术后结局。
术前预先存在的 DSA 的平均荧光强度范围为 1141 至 14695。2 例患者在 LTx 后 2 周内发生抗体介导的排斥反应。7 例患者的 DSA 消失；然而，1 例患者出现 DSA 复发，并死于慢性移植物抗宿主病（CLAD），而 1 例患者在研究期间持续存在 DSA，并死于 CLAD。DSA 阳性与 DSA 阴性患者的总生存率（OS）或 CLAD 无复发生存率（CLAD-FS）无显著差异（P=0.26 和 P=0.17）。然而，DSA 针对 HLA Ⅱ类的患者的 OS 和 CLAD-FS 均显著低于无这些抗体的患者{5 年 OS：25.0%（95%CI：0.9-66.5%）与 72.1%（95%CI：63.8-78.9%），P=0.030 和 5 年 CLAD-FS：26.7%（95%CI：1.0-68.6%）与 73.7%（95%CI：66.5-79.5%），P=0.002}。
预先存在的 DSA 复发和持续存在 DSA 的患者的预后可能较差。具有抗 HLA Ⅱ类预先存在的 DSA 的患者的预后明显更差。
