182-P: LIVING SIMULTANEOUS DOUBLE LUNG TRANSPLANT RECIPIENT WITH POST-TRANSPLANT DQA DSA TOWARDS ONE DONOR

Aim This case study investigates a living simultaneous double lung transplant recipient with post-transplant DQA DSA towards one donor. Methods All post-transplant testing was performed by One Lambda (OLI) FlowPRA ® Screening (FPRA) Class I and II, LABScreen ® Mixed (LSMIX) and LABScreen ® Single Antigen Class I/II (LSA1/2) beads. DQA1 ∗ typings were performed by OLI LABType ® SSO. Results A 33 year old female presented with cystic fibrosis and end stage lung disease and was evaluated for lung transplant in 2000. She was negative by Class I ELISA. The patient was transplanted in Feb 2001 with 2 of 3 potential living donors; the patient’s father and a friend ( Table 1 ). The patient did well post-operatively and was not screened by our lab until 2007. FPRA and LSA were negative. In 2011 the patient was evaluated for declining lung function. The FPRA was Class I 0% Class II 60% with significant architecture. LSA2 revealed strong DQA1 ∗ 04, 05 and 06. DQA typings on the recipient and donors were performed. DSA to DQA1 ∗ 05 was confirmed with donor 1 typing as homozygous DQA1 ∗ 01, donor 2 as DQA1 ∗ 01 DQA1 ∗ 05 and the recipient DQA1 ∗ 01:03 DQA1 ∗ 03. No Class I DSA were detected by LSA. FEV1 correlates with the DSA detected in July 2011. The patient was treated for AMR with thymoglobulin, rituximab and high dose IVIG. Follow up LSA testing in November 2011 and March 2012 reveals persistent antibody to DQA1 ∗ 04, 05 and 06 however they do not appear to be increasing in strength. The recipient currently has some compromised lung function and is being closely monitored. Conclusions This is an interesting case of late AMR due to DQA DSA towards one of two simultaneous living donor lungs. The specificity of the DSA highlights the importance of class II mismatches in late AMR and particularly DQA1 in cases where either DQA1 ∗ 04, 05, or 06 are mismatched and all are absent in the recipient.