Division of Pulmonary and Critical Care Medicine, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Pathology and Laboratory Medicine, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Clin Transplant. 2021 Nov;35(11):e14447. doi: 10.1111/ctr.14447. Epub 2021 Sep 12.
It is unknown whether some donor specific antibodies (DSA) can be crossed at the time of lung transplant without desensitization or augmented induction immunosuppression. This study assessed whether crossing low-level pre-transplant DSA (defined as mean fluorescence intensity [MFI] 1000-6000) without augmented immunosuppression is associated with worse retransplant-free or chronic lung allograft dysfunction (CLAD)-free survival. Of the 458 included recipients, low-level pre-transplant DSA was crossed in 39 (8.6%) patients. The median follow-up time was 2.2 years. There were 15 (38.5%) patients with Class I DSA and 24 (61.5%) with Class II DSA. There was no difference in adjusted overall retransplant-free survival between recipients where pre-transplant DSA was and was not crossed (HR: .98 [95% CI = .49-1.99], P = .96). There was also no difference in CLAD-free survival (HR: .71 [95% CI = .38-1.33], P = .28). There was no difference in Grade 3 PGD at 72 h (OR: 1.13 [95% CI = .52-2.48], P = .75) or definite or probable AMR (HR: 2.22 [95% CI = .64-7.61], P = .21). Lung transplantation in the presence of low-level DSA without planned augmented immunosuppression is not associated with worse overall or CLAD-free survival among recipients with intermediate-term follow-up.
目前尚不清楚在未进行脱敏或增强诱导免疫抑制的情况下，肺移植时是否可以交叉某些供体特异性抗体（DSA）。本研究评估了在未增强免疫抑制的情况下，交叉低水平的移植前 DSA（定义为平均荧光强度[MFI] 1000-6000）是否与较差的无复发性或慢性肺移植物功能障碍（CLAD）无生存相关。在纳入的 458 名受者中，39 名（8.6%）患者发生低水平移植前 DSA 交叉。中位随访时间为 2.2 年。有 15 名（38.5%）患者有 I 类 DSA，24 名（61.5%）有 II 类 DSA。在调整了整体无复发性移植生存后，移植前 DSA 交叉和未交叉的受者之间没有差异（HR：0.98[95%CI=0.49-1.99]，P=0.96）。CLAD 无生存差异也无差异（HR：0.71[95%CI=0.38-1.33]，P=0.28）。72 小时时 3 级 PGD 无差异（OR：1.13[95%CI=0.52-2.48]，P=0.75）或明确或可能的 AMR 也无差异（HR：2.22[95%CI=0.64-7.61]，P=0.21）。在存在低水平 DSA 且未计划增强免疫抑制的情况下进行肺移植，与中期随访中受者的总体或 CLAD 无生存无关。
