单用静脉注射免疫球蛋白为预制供体特异性抗体和流式细胞术交叉配型阴性的肺移植受者脱敏。

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-07-09 DOI:10.1111/ctr.15374

Rayid Abdulqawi, Moheeb Alawwami, Omar Aldosari, Zyad Aldosari, Mohammed Alhuqbani, Rana A. Saleh, Dorina Esendagli, Haifa Aldakhil, Edward B. De Vol, Khaled Alkattan, Kris Ann H. Marquez, Waleed Saleh, Sahar Sandoqa, Eid A. Al-Mutairy

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引用次数: 0

摘要

背景：由于缺乏证据证明对已形成供体特异性抗人类白细胞抗原抗体（DSAs）的肺移植候选者采取最佳脱敏策略，因此各中心对这一患者群体采取了不同的方法。我们机构对已形成供体特异性抗人类白细胞抗原抗体且流式细胞术交叉配型（FCXM）阴性的受者采取的脱敏方案包括静脉注射免疫球蛋白（IVIG）作为唯一疗法。该研究旨在确定采用这种方法的疗效：这项回顾性研究纳入了 2015 年 1 月至 2022 年 3 月期间在一个中心首次接受纯肺移植的成人患者。我们排除了FCXM结果呈阳性或缺失的患者。移植受者在移植后三个月内的最近一次检测中任何 DSA≥1000 MFI 均被视为 DSA 阳性，而 DSA 结果为阳性的受者则被视为 DSA 阳性：167 名符合条件的患者中有 36 人（22%）DSA 阳性。至少有 50%的预处理 DSA 有清除记录（下降至结论：我们描述了一个单中心经验，即对DSA阳性和FCXM阴性的肺移植受者单独使用IVIG。还需要进一步研究，以确认该策略对其他方案的疗效。

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Intravenous Immunoglobulins Alone for the Desensitization of Lung Transplant Recipients with Preformed Donor Specific Antibodies and Negative Flow Cytometry Crossmatch

Background

The lack of evidence regarding optimal desensitization strategies for lung transplant candidates with preformed donor specific anti-human leukocyte antigen antibodies (DSAs) has led to varying approaches among centers towards this patient group. Our institution's desensitization protocol for recipients with preformed DSAs and negative flow cytometry crossmatch (FCXM) consists of intravenous immunoglobulin (IVIG) as the sole therapy. The study aimed to determine outcomes using this approach.

Methods

This retrospective study included adults who underwent lung-only transplantation for the first time between January 2015 and March 2022 at a single center. We excluded patients with positive or missing FCXM results. Transplant recipients with any DSA ≥ 1000 MFI on latest testing within three months of transplant were considered DSA-positive, while recipients with DSAs <1000 MFI and those without DSAs were assigned to the low-level/negative group. Graft survival (time to death/retransplantation) and chronic lung allograft dysfunction (CLAD)-free times were compared between groups using Cox proportional hazards models.

Results

Thirty-six out of 167 eligible patients (22%) were DSA-positive. At least 50% of preformed DSAs had documented clearance (decrease to <1000 MFI) within the first 6 months of transplant. Multivariable Cox regression analyses did not detect a significantly increased risk of graft failure (aHR 1.04 95%CI 0.55–1.97) or chronic lung allograft dysfunction (aHR 0.71 95%CI 0.34–1.52) in DSA-positive patients compared to patients with low-level/negative DSAs. Incidences of antibody-mediated rejection (p = 1.00) and serious thromboembolic events (p = 0.63) did not differ between study groups.

Conclusion

We describe a single-center experience of administering IVIG alone to lung transplant recipients with preformed DSAs and negative FCXM. Further studies are required to confirm the efficacy of this strategy against other protocols.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.