Mohamed Elrefaei MD PhD , Tathagat Narula MD , Francisco Alvarez MD , Elizabeth A. Godbey MD , Jasmine Kendrick , Gerard Criner MD , Francis C. Cordova MD , Norihisa Shigemura MD PhD , Yoshiya Toyoda MD PhD , Olga Timofeeva PhD
{"title":"1:16血清稀释作为肺移植受者HLA抗体介导的排斥治疗血浆交换反应和总生存率预测因子的临床应用：一项双中心研究","authors":"Mohamed Elrefaei MD PhD , Tathagat Narula MD , Francisco Alvarez MD , Elizabeth A. Godbey MD , Jasmine Kendrick , Gerard Criner MD , Francis C. Cordova MD , Norihisa Shigemura MD PhD , Yoshiya Toyoda MD PhD , Olga Timofeeva PhD","doi":"10.1016/j.jhlto.2025.100302","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>Antibody-Mediated Rejection (AMR) due to HLA donor-specific antibodies (DSA) is associated with poor outcomes in lung transplant recipients (LTR). AMR treatment using therapeutic plasma exchange (TPE) improves clinical outcomes in LTR. The objective of this study was to assess the clinical utility of 1:16 serum dilution HLA antibody test results as a predictor of response to TPE for de novo DSA (dnDSA) levels and AMR treatment in LTR.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 32 LTR diagnosed with AMR due to dnDSA and treated with TPE was performed at Mayo Clinic (n = 18) and Temple University Hospital (n = 14). HLA antibodies were detected by Luminex single antigen beads assay. Mean Fluorescence Intensity (MFI) levels were measured in undiluted and 1:16 diluted sera before the 1st and after the 5th TPE session. Statistical analysis was performed using GraphPad PRISM software.</div></div><div><h3>Results</h3><div>Of 32 patients, 14 and 18 patients were diagnosed with early (< 3 months post-transplant) and late (6 months – 3 years post-transplant) AMR respectively. All patients, except one, had HLA Class II dnDSA (97%). In addition, 9/14 (64.2%) and 3/18 (16.6%) of LTR with early and late AMR respectively had HLA class I dnDSA. The MFI for all positive dnDSA in 1:16 diluted sera collected before 1st TPE demonstrated a significant correlation with MFI in undiluted sera collected after 5th TPE in both early (R<sup>2</sup> = 0.8786) and late (R<sup>2</sup> = 0.9045) AMR post-transplant. In addition, MFI in 1:16 diluted pre TPE sera correlated with better overall LTR survival following TPE (p = 0.001).</div></div><div><h3>Conclusion</h3><div>The MFI of 1:16 serum dilution before 1st TPE may be utilized as a surrogate to predict response to TPE for AMR treatment and overall survival in LTR.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100302"},"PeriodicalIF":0.0000,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Clinical utility of 1:16 serum dilution as a predictor of response to therapeutic plasma exchange for HLA antibody-mediated rejection treatment and overall survival in lung transplant recipients: A two center study\",\"authors\":\"Mohamed Elrefaei MD PhD , Tathagat Narula MD , Francisco Alvarez MD , Elizabeth A. Godbey MD , Jasmine Kendrick , Gerard Criner MD , Francis C. Cordova MD , Norihisa Shigemura MD PhD , Yoshiya Toyoda MD PhD , Olga Timofeeva PhD\",\"doi\":\"10.1016/j.jhlto.2025.100302\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>Antibody-Mediated Rejection (AMR) due to HLA donor-specific antibodies (DSA) is associated with poor outcomes in lung transplant recipients (LTR). AMR treatment using therapeutic plasma exchange (TPE) improves clinical outcomes in LTR. The objective of this study was to assess the clinical utility of 1:16 serum dilution HLA antibody test results as a predictor of response to TPE for de novo DSA (dnDSA) levels and AMR treatment in LTR.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 32 LTR diagnosed with AMR due to dnDSA and treated with TPE was performed at Mayo Clinic (n = 18) and Temple University Hospital (n = 14). HLA antibodies were detected by Luminex single antigen beads assay. Mean Fluorescence Intensity (MFI) levels were measured in undiluted and 1:16 diluted sera before the 1st and after the 5th TPE session. Statistical analysis was performed using GraphPad PRISM software.</div></div><div><h3>Results</h3><div>Of 32 patients, 14 and 18 patients were diagnosed with early (< 3 months post-transplant) and late (6 months – 3 years post-transplant) AMR respectively. All patients, except one, had HLA Class II dnDSA (97%). In addition, 9/14 (64.2%) and 3/18 (16.6%) of LTR with early and late AMR respectively had HLA class I dnDSA. The MFI for all positive dnDSA in 1:16 diluted sera collected before 1st TPE demonstrated a significant correlation with MFI in undiluted sera collected after 5th TPE in both early (R<sup>2</sup> = 0.8786) and late (R<sup>2</sup> = 0.9045) AMR post-transplant. In addition, MFI in 1:16 diluted pre TPE sera correlated with better overall LTR survival following TPE (p = 0.001).</div></div><div><h3>Conclusion</h3><div>The MFI of 1:16 serum dilution before 1st TPE may be utilized as a surrogate to predict response to TPE for AMR treatment and overall survival in LTR.</div></div>\",\"PeriodicalId\":100741,\"journal\":{\"name\":\"JHLT Open\",\"volume\":\"9 \",\"pages\":\"Article 100302\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-05-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JHLT Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2950133425000977\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JHLT Open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2950133425000977","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Clinical utility of 1:16 serum dilution as a predictor of response to therapeutic plasma exchange for HLA antibody-mediated rejection treatment and overall survival in lung transplant recipients: A two center study
Purpose
Antibody-Mediated Rejection (AMR) due to HLA donor-specific antibodies (DSA) is associated with poor outcomes in lung transplant recipients (LTR). AMR treatment using therapeutic plasma exchange (TPE) improves clinical outcomes in LTR. The objective of this study was to assess the clinical utility of 1:16 serum dilution HLA antibody test results as a predictor of response to TPE for de novo DSA (dnDSA) levels and AMR treatment in LTR.
Methods
A retrospective analysis of 32 LTR diagnosed with AMR due to dnDSA and treated with TPE was performed at Mayo Clinic (n = 18) and Temple University Hospital (n = 14). HLA antibodies were detected by Luminex single antigen beads assay. Mean Fluorescence Intensity (MFI) levels were measured in undiluted and 1:16 diluted sera before the 1st and after the 5th TPE session. Statistical analysis was performed using GraphPad PRISM software.
Results
Of 32 patients, 14 and 18 patients were diagnosed with early (< 3 months post-transplant) and late (6 months – 3 years post-transplant) AMR respectively. All patients, except one, had HLA Class II dnDSA (97%). In addition, 9/14 (64.2%) and 3/18 (16.6%) of LTR with early and late AMR respectively had HLA class I dnDSA. The MFI for all positive dnDSA in 1:16 diluted sera collected before 1st TPE demonstrated a significant correlation with MFI in undiluted sera collected after 5th TPE in both early (R2 = 0.8786) and late (R2 = 0.9045) AMR post-transplant. In addition, MFI in 1:16 diluted pre TPE sera correlated with better overall LTR survival following TPE (p = 0.001).
Conclusion
The MFI of 1:16 serum dilution before 1st TPE may be utilized as a surrogate to predict response to TPE for AMR treatment and overall survival in LTR.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
