Possible significance of anti-HLA DQ antibodies after lung transplantation – Single centre study

The role of anti-HLA antibodies in solid organ transplantation has long been recognized, particularly with respect to graft rejection and patient survival. This study aimed to evaluate the impact of de novo donor-specific antibodies (DSA) on graft failure and mortality in Polish lung transplant recipients. The study included 112 patients who had a well-defined immune status prior to transplantation. The presence and specificity of anti-HLA antibodies were assessed using the Luminex platform. We identified 26 patients (23%) as having increased immunological risk. Pre-transplant DSAs were detected in 13 recipients. Post-transplantation, the development of de novo DSAs was evaluated, with a cumulative incidence of 11%. Our findings confirmed that lung transplant recipients with donor-specific immunization frequently develop antibodies targeting antigens at the HLA-DQ locus. Notably, 90% (9 out of 10) of immunized patients exhibited high mean fluorescence intensity (MFI) levels of anti-DQ antibodies. These antibodies were shown to be harmful, with mortality significantly higher in immunized patients: 50% of patients with anti-DQ antibodies died, compared to only 15% in those without DSAs. This is the first study of its kind in the Polish population, confirming that strategies to prevent and treat DQ DSAs may improve outcomes for lung transplant recipients.