Transplantation |

Presence of Anti-HLA Antibodies at High Threshold in Patients Listed for Lung Transplantation Is Associated With a Lower Transplant Rate and a Higher Antibody Mediated Rejection Incidence Posttransplant FREE TO VIEW

Miae Kim, PharmD; Keri Townsend, PharmD; Isabelle Wood, BS; Steve Boukedes, BS; Indira Guleria, PhD; Souheil El-Chemaly, MD; Phillip Camp, MD; Anil Chandraker, MD; Edgar Milford, MD; Hilary Goldberg, MD
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Brigham and Women's Hospital, Boston, MA

Chest. 2013;144(4_MeetingAbstracts):1015A. doi:10.1378/chest.1704463
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SESSION TITLE: Lung Transplantation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Limited information exists regarding the prevalence and impact of pre transplant anti-HLA antibodies in patients listed for lung transplantation. We performed a retrospective cohort study to address this question.

METHODS: All patients listed for lung transplantation at our institution between January 2008 and August 2012 were evaluated. We excluded multiple organ transplants and re-transplants. Class I and Class II anti-HLA antibodies were determined at low threshold (mean fluorescence intensity [MFI] 1000-3000) and high threshold (MFI >3000) by Luminex assay.

RESULTS: Among 224 patients listed, 77 (34%) had anti-HLA antibodies at high threshold. Waiting list mortality (9.8%) did not differ among the groups. Significantly fewer patients with antibodies at high threshold received transplants compared to patients with no antibodies (45.5% vs. 68.7%; p=0.005), while there was no difference in the number of transplants between patients with antibodies at low threshold and those without circulating antibodies (p=0.08). There was a trend toward longer time to transplant in patients with antibodies at high threshold (194 ± 215 days) as compared to patients with no antibodies (127 ± 142 days, p=0.10). Patients with antibodies at high threshold were more likely to have positive retrospective flow crossmatches compared to patients without antibodies (22.9% vs. 6.3%, p=0.02). Although the presence of pre transplant anti-HLA antibodies was associated with the presence of donor specific antibodies (DSA) (p<0.001), there was no association with the development of de novo DSAs (p=0.69). Antibody mediated rejection (AMR) requiring treatment was more frequent in patients with antibodies at high threshold (20%) than in patients with antibodies only at low threshold (0%, p=0.01) or no antibodies (6.3 %, p=0.05). Post transplant mortality at six months (8.7%) was not different among these groups.

CONCLUSIONS: The presence of anti-HLA antibodies at high threshold in patients waiting for lung transplantation is associated with a lower transplant rate and a higher incidence of AMR post transplant.

CLINICAL IMPLICATIONS: Screening for anti-HLA antibodies using a high threshold may be beneficial in candidate and recipient management.

DISCLOSURE: The following authors have nothing to disclose: Miae Kim, Keri Townsend, Isabelle Wood, Steve Boukedes, Indira Guleria, Souheil El-Chemaly, Phillip Camp, Anil Chandraker, Edgar Milford, Hilary Goldberg

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