The allograft injury marker CXCL9 determines prognosis of anti-HLA antibodies after lung transplantation.

Autor:	Shino MY; Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Zhang Q; Department of Immunogenetics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Li N; Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Derhovanessian A; Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Ramsey A; Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Saggar R; Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Britton IN; Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Amubieya OO; Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Lari SM; Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Hickey M; Department of Immunogenetics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Reed EF; Department of Immunogenetics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Noble PW; Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA., Stripp BR; Department of Medicine, Cedars Sinai Medical Center, Los Angeles, California, USA., Fishbein GA; Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Lynch JP 3rd; Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Ardehali A; Division of Cardiothoracic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Sayah DM; Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Weigt SS; Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Belperio JA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Jazyk:	angličtina
Zdroj:	American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2022 Feb; Vol. 22 (2), pp. 565-573. Date of Electronic Publication: 2021 Nov 12.
DOI:	10.1111/ajt.16827
Abstrakt:	Despite the common detection of non-donor specific anti-HLA antibodies (non-DSAs) after lung transplantation, their clinical significance remains unclear. In this retrospective single-center cohort study of 325 lung transplant recipients, we evaluated the association between donor-specific HLA antibodies (DSAs) and non-DSAs with subsequent CLAD development. DSAs were detected in 30% of recipients and were associated with increased CLAD risk, with higher HRs for both de novo and high MFI (>5000) DSAs. Non-DSAs were detected in 56% of recipients, and 85% of DSA positive tests had concurrent non-DSAs. In general, non-DSAs did not increase CLAD risk in multivariable models accounting for DSAs. However, non-DSAs in conjunction with high BAL CXCL9 levels were associated with increased CLAD risk. Multivariable proportional hazards models demonstrate the importance of the HLA antibody-CXCL9 interaction: CLAD risk increases when HLA antibodies (both DSAs and non-DSAs) are detected in conjunction with high CXCL9. Conversely, CLAD risk is not increased when HLA antibodies are detected with low CXCL9. This study supports the potential utility of BAL CXCL9 measurement as a biomarker to risk stratify HLA antibodies for future CLAD. The ability to discriminate between high versus low-risk HLA antibodies may improve management by allowing for guided treatment decisions. (© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons.)
Databáze:	MEDLINE
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