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

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) versus persistent dnDSA after transplantation. Methods A single center review of all lung transplants from 1/2009-7/2013. DSAs were tested 8 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<0.05). Overall graft survival was worse for dnDSA-positive versus negative recipients (p=0.025). Of 323 recipients with 1 year follow-up, seventy-two (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=0.007). 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. This article is protected by copyright. All rights reserved.