Impact of Pretransplant Anti-HLA Antibodies on Outcomes in Lung Transplant Candidates

• Published in: American journal of respiratory and critical care medicine 2014-05, Vol.189 (10), p.1234-1239
• Main Authors: KIM, Miae, TOWNSEND, Keri R, GOLDBERG, Hilary J, WOOD, Isabelle G, BOUKEDES, Steve, GULERIA, Indira, GABARDI, Steven, EL-CHEMALY, Souheil, CAMP, Phillip C, CHANDRAKER, Anil K, MILFORD, Edgar L
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibodies; Antigens; Biological and medical sciences; Biomarkers - blood; Candidates; Cohort analysis; Cohort Studies; Disease prevention; FDA approval; Female; Graft Rejection - immunology; Graft Rejection - mortality; Graft Survival - immunology; Histocompatibility Testing; HLA Antigens - blood; Humans; Immunologic Factors - blood; Intensive care medicine; Isoantibodies - blood; Lung Transplantation - mortality; Lung transplants; Male; Medical sciences; Middle Aged; Mortality; Pneumology; Preoperative Care; Retrospective Studies; Tissue Donors; Treatment Outcome
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201312-2160OC

The prevalence of anti-HLA antibodies in lung transplant candidates and their impact on waitlist and transplant outcomes is not known. We examined the prevalence of pretransplant anti-HLA antibodies at varying thresholds and evaluated their impact on outcomes before and after lung transplantation. We performed a single-center retrospective cohort study including all patients listed for lung transplantation between January 2008 and August 2012. Per protocol, transplant candidates were assessed by solid phase LABscreen mixed Class I and II and LABscreen Single Antigen assays. Among 224 patients, 34% had anti-HLA antibodies at mean fluorescent intensity (MFI) greater than or equal to 3,000 (group III), and 24% had antibodies at MFI 1,000 to 3,000 (group II). Ninety percent of the patients with pretransplant anti-HLA antibodies had class I antibodies, whereas only seven patients developed class II alone. Patients in group III were less likely to receive transplants than patients without any anti-HLA antibodies (group I) (45.5 vs. 67.7%, P = 0.005). Wait time to transplant was longer in group III than group I, although this difference did not meet statistical significance, and waitlist mortality was similar. Among transplant recipients, antibody-mediated rejection (AMR) was more frequent in group III than in group II (20% vs. 0%, P = 0.01) or group I (6.3%, P = 0.05). The presence of anti-HLA antibodies at the high MFI threshold (>3,000) was associated with lower transplant rate and higher rates of AMR. Screening for anti-HLA antibodies using the 3,000 MFI threshold may be important in managing transplant candidates and recipients.