Long Term Outcomes of Lung Transplantation in Sensitized Patients Following Eculizumab Use With the Desensitization Protocol.

IF 3 3区 医学 Q1 SURGERY
Transplant International Pub Date : 2025-09-22 eCollection Date: 2025-01-01 DOI:10.3389/ti.2025.15040
Yudai Miyashita, Taisuke Kaiho, David F Pinelli, Anthony Joudi, Mihir John, Austin Chang, Benjamin Louis Thomae, Amanda Kamar, Carl Atkinson, Ankit Bharat, G R Scott Budinger, Ambalavanan Arunachalam, Chitaru Kurihara
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引用次数: 0

Abstract

Lung transplantation remains a life-saving option for end-stage pulmonary diseases, but sensitized patients with anti HLA antibodies carry high risk; recent desensitization advances, such as eculizumab, may permit outcomes comparable to non-sensitized recipients with tailored perioperative care. In this prospective cohort study of 399 adult lung transplant recipients, 36 sensitized patients underwent a protocol combining preoperative plasmapheresis, a defined eculizumab regimen, anti-thymocyte globulin, and IVIG. In comparison, 363 non-sensitized recipients received standard immunosuppression. We compared recipient/donor characteristics, intraoperative parameters, and postoperative outcomes, including primary graft dysfunction, infection, rejection, and overall survival. Desensitized patients were older, predominantly female, and had significantly higher panel reactive antibody levels and preformed donor-specific antibodies; intraoperatively, they required more blood transfusions and VA-ECMO support. Postoperatively, they exhibited higher rates of de novo donor-specific antibodies, antibody-mediated rejection, longer ICU stays, increased dialysis requirement, and more frequent CMV infections. Despite these differences, rates of acute cellular rejection, chronic lung allograft dysfunction, and one-year and overall survival were similar between groups. Our findings suggest that lung transplantation in sensitized patients managed with a desensitization protocol, including eculizumab, is feasible and safe, achieving outcomes comparable to those of non-sensitized recipients.

肺移植仍然是挽救终末期肺部疾病的一种选择,但具有抗HLA抗体的敏感患者具有高风险;最近脱敏治疗的进展,如eculizumab,可能允许与非致敏受体相媲美的结果,并提供量身定制的围手术期护理。在这项对399名成人肺移植受者的前瞻性队列研究中,36名致敏患者接受了术前血浆置换、明确的eculizumab方案、抗胸腺细胞球蛋白和IVIG联合治疗方案。相比之下,363名未致敏的受体接受了标准的免疫抑制。我们比较了受体/供体特征、术中参数和术后结果,包括原发性移植物功能障碍、感染、排斥反应和总生存率。脱敏患者年龄较大,以女性为主,总体反应性抗体水平和预先形成的供体特异性抗体水平明显较高;术中,他们需要更多的输血和VA-ECMO支持。术后,他们表现出更高的新生供体特异性抗体率、抗体介导的排斥反应、更长的ICU住院时间、透析需求增加和更频繁的巨细胞病毒感染。尽管存在这些差异,但两组间的急性细胞排斥反应、慢性同种异体肺功能障碍、一年生存率和总生存率相似。我们的研究结果表明,使用脱敏方案(包括eculizumab)管理的致敏患者的肺移植是可行且安全的,其结果与非致敏受体相当。
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来源期刊
Transplant International
Transplant International 医学-外科
CiteScore
4.70
自引率
6.50%
发文量
211
审稿时长
3-8 weeks
期刊介绍: The aim of the journal is to serve as a forum for the exchange of scientific information in the form of original and high quality papers in the field of transplantation. Clinical and experimental studies, as well as editorials, letters to the editors, and, occasionally, reviews on the biology, physiology, and immunology of transplantation of tissues and organs, are published. Publishing time for the latter is approximately six months, provided major revisions are not needed. The journal is published in yearly volumes, each volume containing twelve issues. Papers submitted to the journal are subject to peer review.
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