Elisabeth Kincaide, Alicia Brenner, Reed Hall, Holly Keyt, Kelley Hitchman, Kelsey Klein
{"title":"Treatment Response of Donor Specific Antibodies and Forced Expiratory Volume in Lung Transplant Recipients With Antibody Mediated Rejection.","authors":"Elisabeth Kincaide, Alicia Brenner, Reed Hall, Holly Keyt, Kelley Hitchman, Kelsey Klein","doi":"10.1016/j.transproceed.2024.10.029","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Antibody-mediated rejection (AMR) is an evolving diagnosis in lung transplantation. The presence of anti-human leukocyte antigen (HLA) donor-specific antibodies (DSAs) does not always correlate with clinical picture, leading to variation in treatment. This study sought to examine anti-HLA DSA response and lung allograft stabilization following AMR treatment.</p><p><strong>Methods: </strong>A single-center, retrospective case series was conducted in adult lung transplant recipients treated for clinical and subclinical AMR. The primary outcome was anti-HLA DSA reduction (≥ 25% decrease in mean fluorescence intensity [MFI]). The secondary outcome was forced expiratory volume (FEV1) stabilization (≤ 10% decline) at peak FEV1 and at 6-months post-treatment.</p><p><strong>Results: </strong>Fifteen bilateral lung transplant recipients were included. Eight (53%) patients achieved the primary outcome with median MFI reduction of -56.7% (interquartile range [IQR] = -41.3 to -69.5). Statistical significance was found on matched pairs analysis between 3 and 6 months post-treatment for anti-HLA DSA reduction. Of the subjects with available data, 7 of 9 (78%) patients had FEV1 stabilization from diagnosis to peak FEV1, and 5 of 7 (71%) patients had stabilization from diagnosis to 6 months post-treatment. A statistically significant decline was found from peak FEV1 post-treatment to 6 months post-treatment (-0.4 L ± 0.2, P = .05). Univariate analysis did not identify predictors affecting anti-HLA DSA response.</p><p><strong>Conclusions: </strong>Anti-HLA DSA response was achieved in approximately half the cohort. A statistically significant decline in FEV1 was seen from peak FEV1 post-treatment but stabilized in most patients by 6 months. These results highlight the difficulty of DSA management and recovering lung function once lost, however, the finding of FEV1 stabilization after treatment is notable.</p>","PeriodicalId":94258,"journal":{"name":"Transplantation proceedings","volume":" ","pages":"2242-2249"},"PeriodicalIF":0.0000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation proceedings","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.transproceed.2024.10.029","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/4 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Antibody-mediated rejection (AMR) is an evolving diagnosis in lung transplantation. The presence of anti-human leukocyte antigen (HLA) donor-specific antibodies (DSAs) does not always correlate with clinical picture, leading to variation in treatment. This study sought to examine anti-HLA DSA response and lung allograft stabilization following AMR treatment.
Methods: A single-center, retrospective case series was conducted in adult lung transplant recipients treated for clinical and subclinical AMR. The primary outcome was anti-HLA DSA reduction (≥ 25% decrease in mean fluorescence intensity [MFI]). The secondary outcome was forced expiratory volume (FEV1) stabilization (≤ 10% decline) at peak FEV1 and at 6-months post-treatment.
Results: Fifteen bilateral lung transplant recipients were included. Eight (53%) patients achieved the primary outcome with median MFI reduction of -56.7% (interquartile range [IQR] = -41.3 to -69.5). Statistical significance was found on matched pairs analysis between 3 and 6 months post-treatment for anti-HLA DSA reduction. Of the subjects with available data, 7 of 9 (78%) patients had FEV1 stabilization from diagnosis to peak FEV1, and 5 of 7 (71%) patients had stabilization from diagnosis to 6 months post-treatment. A statistically significant decline was found from peak FEV1 post-treatment to 6 months post-treatment (-0.4 L ± 0.2, P = .05). Univariate analysis did not identify predictors affecting anti-HLA DSA response.
Conclusions: Anti-HLA DSA response was achieved in approximately half the cohort. A statistically significant decline in FEV1 was seen from peak FEV1 post-treatment but stabilized in most patients by 6 months. These results highlight the difficulty of DSA management and recovering lung function once lost, however, the finding of FEV1 stabilization after treatment is notable.