The Presence of Pretransplant HLA Antibodies Does Not Impact the Development of Chronic Lung Allograft Dysfunction or CLAD Related Death.

Background: Development of Donor-specific Antibodies (DSA) after lung transplantation is associated with antibody mediated rejection (AMR), acute cellular rejection, and bronchiolitis obliterans syndrome (BOS); however, the significance of circulating antibodies before transplant remains unclear. Methods: We performed a retrospective cohort study including recipients of primary lung transplants between 2008 and 2012.We assessed the impact of circulating human leukocyte (HLA) and noncytotoxic Donor Specific antibodies (DSA) detected before transplant on development of Chronic Lung Allograft Dysfunction (CLAD) or CLAD related death. Results: 30% of subjects had circulating class I antibodies alone, 4% Class II, and 14.4% class I and class II at MFI > 1000. 9% of subjects had DSA Class I, 9% Class II and 2.4% both DSA Class 1 and 2. Neither the presence of circulating antibodies (adjusted HR 0.87; 95% CI 0.50 - 1.54 p=0.65) nor the presence of DSA (adjusted HR 1.56; 95% CI 0.77 - 3.18) before transplant at MFI > 1000 was associated with the development of CLAD or CLAD related death. Conclusions: While in previous studies we have shown an increased incidence of AMR in patients with pretransplant DSA, neither the presence of HLA antibodies nor DSA translated to an increased risk of allograft dysfunction or death if prospective crossmatch testing was negative. Prospective studies are needed to define the impact of pretransplant sensitization on lung transplant recipients. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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