Anti-human leukocyte antigen antibodies and preemptive antibody-directed therapy
after lung transplantation.
Author(s): Hachem RR, Yusen RD, Meyers BF, Aloush AA, Mohanakumar T, Patterson GA, Trulock
EP.
Affiliation(s): Division of Pulmonary and Critical Care Medicine, Washington University School of
Medicine, St. Louis, Missouri 63110, USA. Rhachem@dom.wustl.edu
Publication date & source: 2010, J Heart Lung Transplant. , 29(9):973-80
BACKGROUND: Because the development of donor-specific anti-human leukocyte
antigen (HLA) antibodies (DSA) after lung transplantation has been associated
with acute and chronic rejection, we implemented a clinical protocol to screen
all transplant recipients for DSA and preemptively treat those who developed DSA
with rituximab and intravenous immune globulin (IVIG), or IVIG alone.
METHODS: We conducted a prospective observational study of this protocol and used
the LABScreen Single Antigen assay to detect DSA after transplantation. We
compared the incidence of acute rejection, lymphocytic bronchiolitis, and
bronchiolitis obliterans syndrome (BOS) between those who developed DSA and those
who did not using Cox proportional hazards models. We used the Kaplan-Meier
method to compare freedom from BOS and survival between those who had persistent
DSA and those who had successful depletion of DSA.
RESULTS: Among 116 recipients screened, DSA developed in 65 during the study
period. Those who developed DSA and received antibody-directed therapy had a
similar incidence of acute rejection, lymphocytic bronchiolitis, and BOS as those
who did not develop DSA. Furthermore, recipients who had successful depletion of
DSA had greater freedom from BOS and better survival than those who had
persistent DSA. Finally, those treated for DSA had a similar incidence of
infectious complications as those who did not develop DSA.
CONCLUSIONS: The development of DSA is surprisingly common after lung
transplantation. Antibody-directed therapy may reduce the risk of rejection
associated with DSA, but a randomized controlled trial is necessary to critically
evaluate the efficacy of this treatment protocol.
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