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Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizerischen Gesellschaft für Thoraxchirurgie

24.-26.10.2013, Basel, Schweiz

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Donorspecific HLA-antibodies are associated with bronchiolitis obliterans syndrome after lung transplantation

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  • T. Kauke - Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Universitätsklinikum München, München; Labor für Immungenetik, Universitätsklinikum München, München
  • N. Kneidinger - Medizinische Klinik V, Pulmologie, Universitätsklinikum München, München
  • B. Martin - Medizinische Klinik V, Pulmologie, Universitätsklinikum München, München
  • C. Neurohr - Medizinische Klinik V, Pulmologie, Universitätsklinikum München, München
  • R. Hatz - Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Universitätsklinikum München, München
  • H. Winter - Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Universitätsklinikum München, München

Deutsche Gesellschaft für Thoraxchirurgie. Österreichische Gesellschaft für Thoraxchirurgie. Schweizerische Gesellschaft für Thoraxchirurgie. Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizerischen Gesellschaft für Thoraxchirurgie. Basel, Schweiz, 24.-26.10.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocS5.6

doi: 10.3205/13dgt046, urn:nbn:de:0183-13dgt0462

Published: October 14, 2013

© 2013 Kauke et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Several recent studies demonstrated that donor specific HLA-antibodies (DSA) can be correlated with chronic rejection and graft outcome after organ transplantation. The aim of our study was to investigate the clinical relevance of HLA-antibodies (ab) in long-time outcome of lung transplant recipients.

Methods: We performed a study taking blood samples from 120 lung transplant recipients transplanted between 2007 and 2011. The patients were investigated before and after transplantation. The sera were screened by means of Luminex® technology (Gen-Probe, San Diego, USA) for IgG-HLA-class I and class II ab. Using Single Antigen Beads HLA-antibodies in relation to donor’s HLA could be specified. Outcome parameters were bronchiolitis obliterans syndrome (BOS) and biopsy-proven rejection.

Results: 22 out of 120 (18%) patients were positive for HLA-ab after transplantation, with 4 (3.3%) positive for both HLA class I and II ab; 8 (6.6%) positive only for ab against HLA class I, and 15 (12.5%) positive only for HLA class II ab. The incidence of de novo DSA formation was 9/120 patients (7.5%). 5/9 in DSA-positive patients (55%) revealed BOS compared to 17/111 DSA-negative patients (15%) (p=0.012). Remarkably is that 4 out of 5 DSA positive patients suffered from end stage BOS. Episodes of acute cellular rejection and CMV seropositive donors were seen (p=0.05) as an independent risk factor for the development of BOS. But the impact of de novo DSA on the development of BOS was stronger (p=0.018).

Conclusion: Our results indicate that DSA are associated with the development of BOS after lung transplantation. Monitoring of HLA-ab after transplantation is useful in identifying high risk patients and offers an opportunity for early therapeutic intervention.