HLA Sensitization in Patients Bridged to Lung Transplantation With Extracorporeal Membrane Oxygenation.

Autor:	Goetz RL; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL., Kaleekal TS; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL., Wille KM; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL., Orozco-Hernandez E; Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL., Gongora E; Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL., Hoopes CW; Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL., Rusanov V; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL.
Jazyk:	angličtina
Zdroj:	Transplantation direct [Transplant Direct] 2023 Jun 08; Vol. 9 (7), pp. e1497. Date of Electronic Publication: 2023 Jun 08 (Print Publication: 2023).
DOI:	10.1097/TXD.0000000000001497
Abstrakt:	Lung transplantation is a definitive therapy for many end-stage lung pathologies. Extracorporeal membrane oxygenation (ECMO) is increasingly being used as a bridge to lung transplantation (BTT). HLA sensitization is a major barrier to lung transplantation. The development of HLA sensitization while undergoing ECMO support as a BTT has recently been reported in a 2-patient series. Methods: We performed a retrospective analysis of patients undergoing ECMO as a BTT at a single large academic medical center from January 2016 to April 2022. The study was approved by the institutional review board. We selected patients who had undergone ECMO support for at least 7 d with either negative HLA before cannulation or initial negative HLA on ECMO (3 patients). Results: We identified 27 patients bridged to lung transplantation with available HLA data. Of this group, 8 patients (29.6%) developed significant HLA sensitization (>10%). We did not identify any factors predisposing to sensitization, including infection episodes or blood product transfusion. Sensitized patients demonstrated a trend toward an increased primary graft dysfunction rate, a need for posttransplant ECMO support, and a decreased 1-y survival; however, these did not meet statistical significance. Conclusions: Our study is the largest series today describing the association between HLA sensitization and ECMO therapy. We suggest that interaction between the immune system and ECMO circuit contributes to allosensitization pretransplant, similar to that occurring with ventricular assist device. Further work is needed to better characterize the incidence of HLA sensitization in a multicenter cohort and to identify potentially modifiable factors associated with HLA sensitization. Competing Interests: The authors declare no funding or conflicts of interest. (Copyright © 2023 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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