The impact of pre-transplant donor specific anti-HLA antibodies (DSAs) on lung transplant outcome: A single center experience

Introduction: The prevalence and clinical significance of pre-transplant (pre-Txp) donor specific anti-HLA antibodies (DSAs) in lung Txp candidates are unclear. This study was performed to determine the outcome of lung Txp in recipients with known pre-Txp DSA. Materials and Methods: In our single-center retrospective cohort study, we evaluated all first lung transplants between 1/1/2007 and 12/31/2016, with outcomes collected through 1/1/2018. Pre-Txp: DSA were identified to HLA-A, B, C, DR and DQ antigens using a bead-based multiplex assay. Mean florescence intensity (MFI) was used to grade antibody strength. Lung Txp outcomes were evaluated. Results: Our cohort included 457 lung Txp recipients; 39 in patients with DSA. Out of the 39 with pre-Txp DSA; multiple DSAs was reported in 18 (46%), MFI >3000 in 9 (23%), and DSA class 2 in 22 (56.5%) patients. There was no difference in age at transplant in the DSA positive group compared to the rest of transplanted patients (60 vs 62 years, p=0.81). Female patients were significantly more likely to have pre-Txp DSA (p<0.001). Pre-Txp DSA patients were also more likely to receive ATG induction as compared to basiliximab (p=0.005). There was no significant difference PGD 3, in freedom from CLAD (Fig.1), or overall survival (Fig.2) between pre-Txp DSA positive group and those without DSA. Additionally, in pre-Txp positive group, DSA class, DSA MFI, or post-transplant treatment of DSA was not associated with freedom from CLAD or overall survival. Conclusion: Pre-Txp DSA was not associated with post-transplant outcomes, regardless of DSA class, MFI strength, or whether antibody directed treatment was used.