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

• Published in: Transplantation proceedings Vol. 56; no. 10; pp. 2242 - 2249
• Main Authors: Kincaide, Elisabeth, Brenner, Alicia, Hall, Reed, Keyt, Holly, Hitchman, Kelley, Klein, Kelsey
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2024
• Subjects: Adult; Female; Forced Expiratory Volume; Graft Rejection - immunology; HLA Antigens - immunology; Humans; Isoantibodies - blood; Lung Transplantation - adverse effects; Male; Middle Aged; Retrospective Studies; Tissue Donors; Treatment Outcome
• ISSN: 0041-1345; 1873-2623; 1873-2623
• DOI: 10.1016/j.transproceed.2024.10.029

•All patients with AMR had anti-HLA class II DSA.•Majority of lung transplant recipients treated had anti-HLA DSA MFI reduction.•FEV1 stabilization observed at 6 months post-AMR treatment. 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. 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. 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. 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.