Chest
Original ResearchTransplantationImplications for Human Leukocyte Antigen Antibodies After Lung Transplantation: A 10-Year Experience in 441 Patients
Section snippets
Study Cohort
Adults (≥18 years old) receiving a first, cadaveric lung transplant at Duke University Medical Center between January 1, 2000, and October 1, 2008, with at least 30-day survival were eligible for this study. Multiorgan, living lobar, and retransplant recipients were excluded. All recipients received standardized immunosuppression, pulmonary function tests, and transbronchial biopsies as described in the supplemental material (e-Appendix 1).17 The study was approved through the Duke University
Study Cohort Demographics and HLA Evaluation
There were 460 lung transplant recipients who met initial inclusion criteria and were eligible for analysis. A total of 5,813 individual serum samples were evaluated for HLA antibodies, including 2,119 pretransplant samples and 3,694 posttransplant samples. Of these 460 recipients, 19 were subsequently excluded from the analysis because they had no posttransplant HLA-antibody tests. Of the remaining 441 subjects, 139 (32%) had detectable HLA antibodies; these composed the positive HLA-antibody
Discussion
In this large cohort of 441 lung transplant recipients, we have found a strong association between posttransplant HLA antibodies and the subsequent development of BOS and worse survival. Furthermore, the detection of DSA, particularly DSA class II, was associated with significantly worse survival than simply the presence of HLA antibodies. Although somewhat surprising, DSA was not associated with BOS. Our results add to the growing interest in the clinical significance of HLA antibodies by
Acknowledgments
Author contributions: Dr Snyder had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Snyder: contributed to study design, data analysis, manuscript preparation, and served as principal author.
Ms Wang: contributed to data collection and analysis and review of the manuscript.
Dr Chen: contributed to manuscript preparation and review.
Dr Reinsmoen: contributed to manuscript preparation and review.
Ms
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Funding/Support: This work was supported by the National Institutes of Health (NIH) [grant KL2RR024127] and the American Society of Transplantation Clinical Faculty Development Award (Dr Snyder), and by the NIH/National Heart Lung and Blood Institute SCCOR [grants 1P50-HL084917-01 and K24-091140-01] (Dr Palmer).
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