Lung transplantation despite preformed donor-specific antihuman leukocyte antigen antibodies: a 9-year single-center experience.

Autor:	Heise EL; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Chichelnitskiy E; Department of Transplantation Immunology, Hannover Medical School, Hannover, Germany., Greer M; Department of Respiratory Medicine,Hannover Medical School,Hannover,Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany., Franz M; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Aburahma K; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Iablonskii P; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany; Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russia., de Manna ND; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Christoph S; Department of Transplantation Immunology, Hannover Medical School, Hannover, Germany., Verboom M; Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany., Hallensleben M; Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany., Boethig D; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Avsar M; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Welte T; Department of Respiratory Medicine,Hannover Medical School,Hannover,Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany., Schwerk N; Department of Pediatric Pneumology Allergology and Neonatology, Hannover Medical School, Hannover, Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany., Sommer W; Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany., Haverich A; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany., Warnecke G; Department of Cardiac Surgery, Heidelberg Medical School, Heidelberg, Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany., Kuehn C; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany., Falk C; Department of Transplantation Immunology, Hannover Medical School, Hannover, Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany., Salman J; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany., Ius F; Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany; Member of the German Center for Lung Research (DZL), Hannover/Heidelberg, Germany. Electronic address: ius.fabio@mh-hannover.de.
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] 2023 Nov; Vol. 23 (11), pp. 1740-1756. Date of Electronic Publication: 2023 May 22.
DOI:	10.1016/j.ajt.2023.04.034
Abstrakt:	Pretransplant allosensitization to human leukocyte antigens (HLA) increases the recipient's waiting list time and mortality in lung transplantation. Rather than waiting for crossmatch-negative donors, since 2013, recipients with preformed donor-specific antiHLA antibodies (pfDSA) have been managed with repeated IgA- and IgM-enriched intravenous immunoglobulin (IgGAM) infusions, usually in combination with plasmapheresis before IgGAM and a single dose of antiCD20 antibody. This retrospective study presents our 9-year experience with patients transplanted with pfDSA. Records of patients transplanted between February 2013 and May 2022 were reviewed. Outcomes were compared between patients with pfDSA and those without any de novo donor-specific antiHLA antibodies. The median follow-up time was 50 months. Of the 1,043 patients who had undergone lung transplantation, 758 (72.7%) did not develop any early donor-specific antiHLA antibodies, and 62 (5.9%) patients exhibited pfDSA. Among the 52 (84%) patients who completed treatment, pfDSA was cleared in 38 (73%). In pfDSA vs control patients and at 8-year follow-up, respectively, graft survival (%) was 75 vs 65 (P = .493) and freedom from chronic lung allograft dysfunction (%) was 63 vs 65 (P = .525). In lung transplantation, crossing the preformed HLA-antibody barrier is safe using a treatment protocol based on IgGAM. Patients with pfDSA have a good 8-year graft survival rate and freedom from chronic lung allograft dysfunction, similar to control patients. Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Fabio Ius reports financial support was provided by Biotest AG. Christine Falk reports financial support was provided by Biotest AG. Christine Falk reports financial support was provided by SFB 738 B3. Fabio Ius reports a relationship with Biotest AG that includes: consulting or advisory, funding grants, speaking and lecture fees, and travel reimbursement. Gregor Warnecke and Wiebke Sommer declare congress fees, study grants and honorary for lectures paid by Biotest AG. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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