82 Antibody Directed Therapy for DSA Results in Diminished Autoimmune Response and Favorable Long Term Outcome Following Human Lung Transplantation

Purpose Current evidence demonstrates an important role for cross talk between alloimmunity and autoimmunity in the pathogenesis of chronic rejection following human lung transplantation (LTx) manifested as bronchiolitis obliterans syndrome (BOS). We recently demonstrated that preemptive antibody directed therapy (IVIG and Rituximab) in patients who develop de novo anti-HLA antibodies (DSA) resulted in removal of DSA and greater freedom from BOS. The goal of this study is to determine the impact of antibody directed therapy on autoimmunity and its influence in reducing the incidence of BOS. Methods and Materials Adult lung transplant recipients (n=116) were analyzed. BOS was diagnosed by ISHLT guidelines. DSA were measured by LABScreen Single antigen beads by Luminex every 3 months, antibodies (Abs) to self-antigens K-α1-tubulin (Kα1T) and Collagen V (Col-V) by ELISA and cytokines by Luminex kit. Results Among 116 LTx, 65 developed DSA within 3 months of LTx and were treated with IVIG and/or rituximab. Among the DSA cleared BOS- patients (n=28), there was a significant drop in Abs to Col-V (from 23/28 to 12/28) and Kα1T (from 25/28 to 14/28, p Conclusions Our results demonstrate that antibody directed therapy results in decreased circulating levels of pro inflammatory cytokines and development of auto-Abs and increased freedom from BOS.