Evolving experience of treating antibody-mediated rejection following lung transplantation

Shinji Otani, Amanda K. Davis, Linda Cantwell, Steven Ivulich, Alan Pham, Miranda A. Paraskeva, Greg I. Snell, Glen P. Westall

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)

Abstract

Background: The importance of antibody-mediated rejection (AMR) following lung transplantation remains contentious. In particular, the diagnostic criteria suggested to define AMR, namely the presence of donor-specific antibodies (DSA), C4d immunoreactivity, histological features and allograft dysfunction are not always readily applicable or confirmatory in lung transplantation. Methods: In a retrospective single-center study of 255 lung transplant recipients (LTR), we identified 9 patients in whom a clinical diagnosis of AMR was made within 12. months of transplant, and define the immunological, histological, clinical features, as well as the therapeutic response of this cohort. Results: Nine LTR with AMR underwent combination therapy with high-dose intravenous corticosteroid, intravenous immunoglobulin, plasmapheresis and rituximab. Following therapy, while the total number of the original DSA dropped by 17%, and the median value of the mean fluorescence intensity (mfi) of the originally observed DSA decreased from 5292 (IQR 1319-12,754) to 2409 (IQR 920-6825) (p. <. 0.001), clinical outcomes were variable with a number of patients progressing to either chronic lung allograft dysfunction or death within 12. month. Conclusion: AMR in lung transplantation remains both a diagnostic and therapeutic challenge, but when clinically suspected is associated with a variable response to therapy and poor long-term outcomes.

Original languageEnglish
Pages (from-to)75-80
Number of pages6
JournalTransplant Immunology
Volume31
Issue number2
DOIs
Publication statusPublished - Aug 2014
Externally publishedYes

Keywords

  • Antibody-mediated rejection
  • Bronchiolitis obliterans syndrome
  • Chronic lung allograft syndrome
  • Lung transplantation
  • Plasmapheresis
  • Rituximab

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Transplantation

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