Preemptive treatment of de novo donor-specific antibodies in lung transplant patients reduces subsequent risk of chronic lung allograft dysfunction or death

Michael Keller, Song Yang, Lucia Ponor, Ann Bon, Adam Cochrane, Mary Carmelle Philogene, Errol Bush, Pali Shah, Joby Mathew, Anne W. Brown, Hyesik Kong, Ananth Charya, Helen Luikart, Steven D. Nathan, Kiran K. Khush, Moon Jang, Sean Agbor-Enoh

Research output: Contribution to journalArticlepeer-review

Abstract

The development of donor-specific antibodies after lung transplantation is associated with downstream acute cellular rejection, antibody-mediated rejection (AMR), chronic lung allograft dysfunction (CLAD), or death. It is unknown whether preemptive (early) treatment of de novo donor-specific antibodies (dnDSAs), in the absence of clinical signs and symptoms of allograft dysfunction, reduces the risk of subsequent CLAD or death. We performed a multicenter, retrospective cohort study to determine if early treatment of dnDSAs in lung transplant patients reduces the risk of the composite endpoint of CLAD or death. In the cohort of 445 patients, 145 patients developed dnDSAs posttransplant. Thirty patients received early targeted treatment for dnDSAs in the absence of clinical signs and symptoms of AMR. Early treatment of dnDSAs was associated with a decreased risk of CLAD or death (hazard ratio, 0.36; 95% confidence interval, 0.17-0.76; P < .01). Deferring treatment until the development of clinical AMR was associated with an increased risk of CLAD or death (hazard ratio, 3.00; 95% confidence interval, 1.46-6.18; P < .01). This study suggests that early, preemptive treatment of donor-specific antibodies in lung transplant patients may reduce the subsequent risk of CLAD or death.

Original languageEnglish (US)
Pages (from-to)559-564
Number of pages6
JournalAmerican Journal of Transplantation
Volume23
Issue number4
DOIs
StatePublished - Apr 2023

Keywords

  • clinical research/practice
  • lung transplantation/pulmonology
  • lung transplantation: living donor
  • rejection
  • rejection: antibody-mediated (ABMR)

ASJC Scopus subject areas

  • Transplantation
  • Pharmacology (medical)
  • Immunology and Allergy

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