Lydia E. Federico MPhil , Joshua M. Diamond MD, MSCE , Malek Kamoun MD, PhD , Maria M. Crespo MD , Christian A. Bermudez MD , Andrew M. Courtwright MD, PhD
{"title":"体外膜氧合-桥接肺移植受者体内的捐献者特异性抗体","authors":"Lydia E. Federico MPhil , Joshua M. Diamond MD, MSCE , Malek Kamoun MD, PhD , Maria M. Crespo MD , Christian A. Bermudez MD , Andrew M. Courtwright MD, PhD","doi":"10.1016/j.atssr.2024.06.021","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation. Although other mechanical circulatory support devices have been associated with anti-human leukocyte antigen antibody formation, including de novo donor-specific antibodies (dnDSA), it is unknown whether ECMO is a sensitizing exposure.</div></div><div><h3>Methods</h3><div>This was a single-center retrospective cohort study of lung transplant recipients. We compared dnDSA development in ECMO-bridged and non-ECMO exposed recipients. We also assessed differences in chronic lung allograft dysfunction-free survival between ECMO-bridged recipients with and without dnDSA, and between those who developed dnDSA with and without ECMO bridge.</div></div><div><h3>Results</h3><div>Among 299 transplant recipients, 48 were ECMO-bridged and 251 were non-ECMO exposed. dnDSA developed in 33.3% of ECMO-bridged and 21.5% of non-ECMO exposed recipients. ECMO was associated with dnDSA development in bivariate (hazard ratio [HR], 2.08, 95% CI, 1.19-3.64, <em>P</em> = .01) but not multivariate analysis after adjusting for known confounders (HR, 1.10, 95% CI, 0.50-2.42, <em>P</em> = .82). Higher posttransplant transfusion volume was independently associated with dnDSA development (HR, 4.68, 95% CI, 2.25-9.72, <em>P</em> < .001). ECMO-bridged recipients with dnDSA did not have worse adjusted chronic lung allograft dysfunction-free survival than those without dnDSA (HR, 0.35, 95% CI, 0.07-1.87, <em>P</em> = .22) or compared to non-ECMO exposed recipients with dnDSA (HR, 0.40, 95% CI, 0.08-2.00, <em>P</em> = .27).</div></div><div><h3>Conclusions</h3><div>A more restrictive posttransplant transfusion threshold among ECMO-bridged lung transplant recipients may reduce the risk of dnDSA. Surveillance for dnDSA, at least among ECMO-bridged recipients, may only be necessary in the presence of allograft dysfunction.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 836-841"},"PeriodicalIF":0.0000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Donor Specific Antibodies in Extracorporeal Membrane Oxygenation-Bridged Lung Transplant Recipients\",\"authors\":\"Lydia E. Federico MPhil , Joshua M. Diamond MD, MSCE , Malek Kamoun MD, PhD , Maria M. Crespo MD , Christian A. Bermudez MD , Andrew M. Courtwright MD, PhD\",\"doi\":\"10.1016/j.atssr.2024.06.021\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation. Although other mechanical circulatory support devices have been associated with anti-human leukocyte antigen antibody formation, including de novo donor-specific antibodies (dnDSA), it is unknown whether ECMO is a sensitizing exposure.</div></div><div><h3>Methods</h3><div>This was a single-center retrospective cohort study of lung transplant recipients. We compared dnDSA development in ECMO-bridged and non-ECMO exposed recipients. We also assessed differences in chronic lung allograft dysfunction-free survival between ECMO-bridged recipients with and without dnDSA, and between those who developed dnDSA with and without ECMO bridge.</div></div><div><h3>Results</h3><div>Among 299 transplant recipients, 48 were ECMO-bridged and 251 were non-ECMO exposed. dnDSA developed in 33.3% of ECMO-bridged and 21.5% of non-ECMO exposed recipients. ECMO was associated with dnDSA development in bivariate (hazard ratio [HR], 2.08, 95% CI, 1.19-3.64, <em>P</em> = .01) but not multivariate analysis after adjusting for known confounders (HR, 1.10, 95% CI, 0.50-2.42, <em>P</em> = .82). Higher posttransplant transfusion volume was independently associated with dnDSA development (HR, 4.68, 95% CI, 2.25-9.72, <em>P</em> < .001). ECMO-bridged recipients with dnDSA did not have worse adjusted chronic lung allograft dysfunction-free survival than those without dnDSA (HR, 0.35, 95% CI, 0.07-1.87, <em>P</em> = .22) or compared to non-ECMO exposed recipients with dnDSA (HR, 0.40, 95% CI, 0.08-2.00, <em>P</em> = .27).</div></div><div><h3>Conclusions</h3><div>A more restrictive posttransplant transfusion threshold among ECMO-bridged lung transplant recipients may reduce the risk of dnDSA. Surveillance for dnDSA, at least among ECMO-bridged recipients, may only be necessary in the presence of allograft dysfunction.</div></div>\",\"PeriodicalId\":72234,\"journal\":{\"name\":\"Annals of thoracic surgery short reports\",\"volume\":\"2 4\",\"pages\":\"Pages 836-841\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of thoracic surgery short reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S277299312400264X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of thoracic surgery short reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S277299312400264X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Donor Specific Antibodies in Extracorporeal Membrane Oxygenation-Bridged Lung Transplant Recipients
Background
Extracorporeal membrane oxygenation (ECMO) is increasingly used as a bridge to lung transplantation. Although other mechanical circulatory support devices have been associated with anti-human leukocyte antigen antibody formation, including de novo donor-specific antibodies (dnDSA), it is unknown whether ECMO is a sensitizing exposure.
Methods
This was a single-center retrospective cohort study of lung transplant recipients. We compared dnDSA development in ECMO-bridged and non-ECMO exposed recipients. We also assessed differences in chronic lung allograft dysfunction-free survival between ECMO-bridged recipients with and without dnDSA, and between those who developed dnDSA with and without ECMO bridge.
Results
Among 299 transplant recipients, 48 were ECMO-bridged and 251 were non-ECMO exposed. dnDSA developed in 33.3% of ECMO-bridged and 21.5% of non-ECMO exposed recipients. ECMO was associated with dnDSA development in bivariate (hazard ratio [HR], 2.08, 95% CI, 1.19-3.64, P = .01) but not multivariate analysis after adjusting for known confounders (HR, 1.10, 95% CI, 0.50-2.42, P = .82). Higher posttransplant transfusion volume was independently associated with dnDSA development (HR, 4.68, 95% CI, 2.25-9.72, P < .001). ECMO-bridged recipients with dnDSA did not have worse adjusted chronic lung allograft dysfunction-free survival than those without dnDSA (HR, 0.35, 95% CI, 0.07-1.87, P = .22) or compared to non-ECMO exposed recipients with dnDSA (HR, 0.40, 95% CI, 0.08-2.00, P = .27).
Conclusions
A more restrictive posttransplant transfusion threshold among ECMO-bridged lung transplant recipients may reduce the risk of dnDSA. Surveillance for dnDSA, at least among ECMO-bridged recipients, may only be necessary in the presence of allograft dysfunction.