TY - JOUR
T1 - Preemptive treatment of de novo donor-specific antibodies in lung transplant patients reduces subsequent risk of chronic lung allograft dysfunction or death
AU - Keller, Michael
AU - Yang, Song
AU - Ponor, Lucia
AU - Bon, Ann
AU - Cochrane, Adam
AU - Philogene, Mary Carmelle
AU - Bush, Errol
AU - Shah, Pali
AU - Mathew, Joby
AU - Brown, Anne W.
AU - Kong, Hyesik
AU - Charya, Ananth
AU - Luikart, Helen
AU - Nathan, Steven D.
AU - Khush, Kiran K.
AU - Jang, Moon
AU - Agbor-Enoh, Sean
N1 - Funding Information:
The authors would like to thank Kelly Byrnes for her help in constructing the figures and tables for this manuscript.
Publisher Copyright:
© 2023
PY - 2023/4
Y1 - 2023/4
N2 - 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.
AB - 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.
KW - clinical research/practice
KW - lung transplantation/pulmonology
KW - lung transplantation: living donor
KW - rejection
KW - rejection: antibody-mediated (ABMR)
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U2 - 10.1016/j.ajt.2022.12.019
DO - 10.1016/j.ajt.2022.12.019
M3 - Article
C2 - 36732088
AN - SCOPUS:85150299715
SN - 1600-6135
VL - 23
SP - 559
EP - 564
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 4
ER -