抗体介导排斥的肺移植受者供体特异性抗体和用力呼气量的治疗反应。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2024-12-01 DOI:10.1016/j.transproceed.2024.10.029

Elisabeth Kincaide , Alicia Brenner , Reed Hall , Holly Keyt , Kelley Hitchman , Kelsey Klein

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引用次数: 0

摘要

背景：抗体介导的排斥反应（AMR）是肺移植中一个不断发展的诊断。抗人白细胞抗原（HLA）供体特异性抗体（dsa）的存在并不总是与临床表现相关，导致治疗的变化。本研究旨在检测AMR治疗后抗hla - DSA反应和肺同种异体移植物稳定性。方法：对临床和亚临床AMR治疗的成人肺移植受者进行单中心、回顾性病例系列研究。主要结局为抗hla - DSA降低（平均荧光强度[MFI]降低≥25%）。次要终点是FEV1峰值和治疗后6个月的用力呼气量（FEV1）稳定（≤10%下降）。结果：纳入15例双侧肺移植受者。8例（53%）患者达到了主要终点，中位MFI降低了-56.7%（四分位数范围[IQR] = -41.3至-69.5）。治疗后3 ~ 6个月抗hla - DSA降低的配对分析有统计学意义。在有可用数据的受试者中，9例患者中有7例（78%）从诊断到FEV1峰值稳定，7例患者中有5例（71%）从诊断到治疗后6个月稳定。治疗后6个月FEV1峰值下降有统计学意义（-0.4 L±0.2,P = 0.05）。单因素分析未发现影响抗hla - DSA反应的预测因素。结论：在大约一半的队列中实现了抗hla - DSA反应。从治疗后的FEV1峰值来看，FEV1有统计学意义上的下降，但大多数患者在6个月后稳定下来。这些结果强调了DSA治疗和恢复肺功能一旦失去的困难，然而，治疗后FEV1稳定的发现是值得注意的。

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Treatment Response of Donor Specific Antibodies and Forced Expiratory Volume in Lung Transplant Recipients With Antibody Mediated Rejection

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.

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.