De-novo donor-specific anti-HLA antibodies 30 days after lung transplantation are associated with a worse outcome
| Autor: | Jérôme Le Pavec, Olaf Mercier, Elie Fadel, François Stéphan, Peter Dorfmüller, Laurent Savale, Sacha Mussot, Séverine Feuillet, Caroline Suberbielle, Lilia Lamrani |
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| Rok vydání: | 2015 |
| Předmět: |
0301 basic medicine
Pulmonary and Respiratory Medicine Graft Rejection medicine.medical_specialty medicine.medical_treatment 030230 surgery Gastroenterology Isoantibodies 03 medical and health sciences 0302 clinical medicine HLA Antigens Internal medicine Extracorporeal membrane oxygenation Medicine Lung transplantation Humans Survival rate Kidney transplantation Antilymphocyte Serum Transplantation Lung business.industry Hazard ratio Graft Survival medicine.disease Kidney Transplantation Confidence interval Tissue Donors Surgery Survival Rate 030104 developmental biology medicine.anatomical_structure Female Cardiology and Cardiovascular Medicine business Lung Transplantation |
| Zdroj: | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 35(9) |
| ISSN: | 1557-3117 |
| Popis: | The impact of de-novo donor-specific anti-HLA antibodies (DSA) on patient and graft survival after lung transplantation remains controversial. We analyzed DSA that developed at Day 7 and Month (M) 1, M3, M6 and M12 after lung transplantation and evaluated their impact on chronic lung allograft dysfunction (CLAD) development and survival.One hundred thirty-four patients who underwent lung transplantation at our institution between November 2007 and August 2013 were included in this study. During the first post-transplant year, 82 (61%) patients developed de novo DSA and 52 (39%) patients did not. Three mean fluorescence intensity (MFI) intervals were used to define scores of anti-HLA antibody positivity: score 4 if MFI was 500 to 1,000; score 6 if MFI was 1,000 to 3,000; and score 8 if MFI was ≥3,000. Patients' records were retrospectively reviewed.DSA with MFI scores of ≥4 (hazard ratio [HR] 2.21, 95% confidence interval [CI] 1.08 to 4.54, p = 0.03), 6 (HR 2.63, 95% CI 1.27 to 5.20, p0.01) and 8 (HR 2.83, 95% CI 1.42 to 5.67, p0.01) at M1; female gender (HR 0.49, 95% CI 0.28 to 0.87, P = 0.01); and with post-operative extracorporeal membrane oxygenation (HR 0.09, 95% CI 0.01 to 0.28, p = 0.02) were significantly associated with CLAD. Multivariate analysis identified score 8 at M1 (HR 2.71, 95% CI 1.34 to 5.47, p0.01) as an independent risk factor for mortality. Overall, 1-, 3- and 5-year survival rates were 76%, 52% and 41% compared with 84%, 74% and 70% for patients with or without de-novo DSA at M1, respectively (p = 0.02).Early de-novo DSA may significantly impact long-term outcomes after lung transplantation and should therefore prompt regular screening. |
| Databáze: | OpenAIRE |
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