Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation

Research output: Contribution to journalArticle

Ana K Islam, Neeraj Sinha, Jennifer M DeVos, Thomas S Kaleekal, Soma S Jyothula, Larry D. Teeter, Duc T M Nguyen, Todd N Eagar, Linda W Moore, Mamta Puppala, Stephen T C Wong, Richard J Knight, Adaani E Frost, Edward A Graviss, A Osama Gaber

BACKGROUND: The natural history of de novo donor-specific antibodies (dnDSA) after lung transplantation is not well-described. We sought to determine the incidence and risk factors associated with dnDSA and compare outcomes between recipients with transient (or isolated) vs persistent dnDSA after transplantation.

METHODS: A single-center review of all lung transplants from 1/2009-7/2013. DSAs were tested eight times in the first year and every 4 months thereafter. Outcomes examined included acute rejection and graft failure.

RESULTS: Median follow-up was 18 months (range: 1-61 months), and 24.6% of 333 first-time lung-only transplant recipients developed a dnDSA. Ethnicity, HLA-DQ mismatches, post-transplantation platelet transfusion and Lung Allocation Score >60 were associated with dnDSA (P<.05). Overall graft survival was worse for dnDSA-positive vs negative recipients (P=.025). Of 323 recipients with 1-year follow-up, 72 (22.2%) developed dnDSA, and in 25 (34.7%), the dnDSA was transient and cleared. Recipients with transient dnDSA were less likely to develop acute rejection than those with persistent dnDSA (P=.007).

CONCLUSIONS: Early post-lung transplantation, dnDSA occurred in 1/4 of recipients, was associated with peri-transplant risk factors and resulted in decreased survival. Spontaneous clearance of dnDSA, seen in one-third of recipients, was associated with a lower risk of acute rejection.

Original languageEnglish (US)
JournalClinical Transplantation
DOIs
StateE-pub ahead of print - Jun 28 2017

PMID: 28658512

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Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation. / Islam, Ana K; Sinha, Neeraj; DeVos, Jennifer M; Kaleekal, Thomas S; Jyothula, Soma S; Teeter, Larry D.; Nguyen, Duc T M; Eagar, Todd N; Moore, Linda W; Puppala, Mamta; Wong, Stephen T C; Knight, Richard J; Frost, Adaani E; Graviss, Edward A; Osama Gaber, A.

In: Clinical Transplantation, 28.06.2017.

Research output: Contribution to journalArticle

Harvard

Islam, AK, Sinha, N, DeVos, JM, Kaleekal, TS, Jyothula, SS, Teeter, LD, Nguyen, DTM, Eagar, TN, Moore, LW, Puppala, M, Wong, STC, Knight, RJ, Frost, AE, Graviss, EA & Osama Gaber, A 2017, 'Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation' Clinical Transplantation. https://doi.org/10.1111/ctr.13028

APA

Islam, A. K., Sinha, N., DeVos, J. M., Kaleekal, T. S., Jyothula, S. S., Teeter, L. D., ... Osama Gaber, A. (2017). Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation. Clinical Transplantation. https://doi.org/10.1111/ctr.13028

Vancouver

Islam AK, Sinha N, DeVos JM, Kaleekal TS, Jyothula SS, Teeter LD et al. Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation. Clinical Transplantation. 2017 Jun 28. https://doi.org/10.1111/ctr.13028

Author

Islam, Ana K ; Sinha, Neeraj ; DeVos, Jennifer M ; Kaleekal, Thomas S ; Jyothula, Soma S ; Teeter, Larry D. ; Nguyen, Duc T M ; Eagar, Todd N ; Moore, Linda W ; Puppala, Mamta ; Wong, Stephen T C ; Knight, Richard J ; Frost, Adaani E ; Graviss, Edward A ; Osama Gaber, A. / Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation. In: Clinical Transplantation. 2017.

BibTeX

@article{dbdd9f02b8a44157832ffc505c85c23e,
title = "Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation",
abstract = "BACKGROUND: The natural history of de novo donor-specific antibodies (dnDSA) after lung transplantation is not well-described. We sought to determine the incidence and risk factors associated with dnDSA and compare outcomes between recipients with transient (or isolated) vs persistent dnDSA after transplantation.METHODS: A single-center review of all lung transplants from 1/2009-7/2013. DSAs were tested eight times in the first year and every 4 months thereafter. Outcomes examined included acute rejection and graft failure.RESULTS: Median follow-up was 18 months (range: 1-61 months), and 24.6{\%} of 333 first-time lung-only transplant recipients developed a dnDSA. Ethnicity, HLA-DQ mismatches, post-transplantation platelet transfusion and Lung Allocation Score >60 were associated with dnDSA (P<.05). Overall graft survival was worse for dnDSA-positive vs negative recipients (P=.025). Of 323 recipients with 1-year follow-up, 72 (22.2{\%}) developed dnDSA, and in 25 (34.7{\%}), the dnDSA was transient and cleared. Recipients with transient dnDSA were less likely to develop acute rejection than those with persistent dnDSA (P=.007).CONCLUSIONS: Early post-lung transplantation, dnDSA occurred in 1/4 of recipients, was associated with peri-transplant risk factors and resulted in decreased survival. Spontaneous clearance of dnDSA, seen in one-third of recipients, was associated with a lower risk of acute rejection.",
keywords = "Journal Article",
author = "Islam, {Ana K} and Neeraj Sinha and DeVos, {Jennifer M} and Kaleekal, {Thomas S} and Jyothula, {Soma S} and Teeter, {Larry D.} and Nguyen, {Duc T M} and Eagar, {Todd N} and Moore, {Linda W} and Mamta Puppala and Wong, {Stephen T C} and Knight, {Richard J} and Frost, {Adaani E} and Graviss, {Edward A} and {Osama Gaber}, A",
note = "{\circledC} 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.",
year = "2017",
month = "6",
day = "28",
doi = "10.1111/ctr.13028",
language = "English (US)",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley",

}

RIS

TY - JOUR

T1 - Early clearance vs persistence of de novo donor-specific antibodies following lung transplantation

AU - Islam, Ana K

AU - Sinha, Neeraj

AU - DeVos, Jennifer M

AU - Kaleekal, Thomas S

AU - Jyothula, Soma S

AU - Teeter, Larry D.

AU - Nguyen, Duc T M

AU - Eagar, Todd N

AU - Moore, Linda W

AU - Puppala, Mamta

AU - Wong, Stephen T C

AU - Knight, Richard J

AU - Frost, Adaani E

AU - Graviss, Edward A

AU - Osama Gaber, A

N1 - © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

PY - 2017/6/28

Y1 - 2017/6/28

N2 - BACKGROUND: The natural history of de novo donor-specific antibodies (dnDSA) after lung transplantation is not well-described. We sought to determine the incidence and risk factors associated with dnDSA and compare outcomes between recipients with transient (or isolated) vs persistent dnDSA after transplantation.METHODS: A single-center review of all lung transplants from 1/2009-7/2013. DSAs were tested eight times in the first year and every 4 months thereafter. Outcomes examined included acute rejection and graft failure.RESULTS: Median follow-up was 18 months (range: 1-61 months), and 24.6% of 333 first-time lung-only transplant recipients developed a dnDSA. Ethnicity, HLA-DQ mismatches, post-transplantation platelet transfusion and Lung Allocation Score >60 were associated with dnDSA (P<.05). Overall graft survival was worse for dnDSA-positive vs negative recipients (P=.025). Of 323 recipients with 1-year follow-up, 72 (22.2%) developed dnDSA, and in 25 (34.7%), the dnDSA was transient and cleared. Recipients with transient dnDSA were less likely to develop acute rejection than those with persistent dnDSA (P=.007).CONCLUSIONS: Early post-lung transplantation, dnDSA occurred in 1/4 of recipients, was associated with peri-transplant risk factors and resulted in decreased survival. Spontaneous clearance of dnDSA, seen in one-third of recipients, was associated with a lower risk of acute rejection.

AB - BACKGROUND: The natural history of de novo donor-specific antibodies (dnDSA) after lung transplantation is not well-described. We sought to determine the incidence and risk factors associated with dnDSA and compare outcomes between recipients with transient (or isolated) vs persistent dnDSA after transplantation.METHODS: A single-center review of all lung transplants from 1/2009-7/2013. DSAs were tested eight times in the first year and every 4 months thereafter. Outcomes examined included acute rejection and graft failure.RESULTS: Median follow-up was 18 months (range: 1-61 months), and 24.6% of 333 first-time lung-only transplant recipients developed a dnDSA. Ethnicity, HLA-DQ mismatches, post-transplantation platelet transfusion and Lung Allocation Score >60 were associated with dnDSA (P<.05). Overall graft survival was worse for dnDSA-positive vs negative recipients (P=.025). Of 323 recipients with 1-year follow-up, 72 (22.2%) developed dnDSA, and in 25 (34.7%), the dnDSA was transient and cleared. Recipients with transient dnDSA were less likely to develop acute rejection than those with persistent dnDSA (P=.007).CONCLUSIONS: Early post-lung transplantation, dnDSA occurred in 1/4 of recipients, was associated with peri-transplant risk factors and resulted in decreased survival. Spontaneous clearance of dnDSA, seen in one-third of recipients, was associated with a lower risk of acute rejection.

KW - Journal Article

U2 - 10.1111/ctr.13028

DO - 10.1111/ctr.13028

M3 - Article

JO - Clinical Transplantation

T2 - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

ER -

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