Long-term outcomes of sensitized lung transplant recipients after peri-operative desensitization

Abstract

Lung transplantation in the setting of preformed donor-specific antibodies (DSA) is frequently avoided due to the risk of hyperacute rejection, early antibody-mediated rejection, and earlier onset of chronic lung allograft dysfunction (CLAD). [1][2][3][4][5][6][7][8] Most lung transplant programs perform virtual crossmatching (VCM) at the time of a donor offer and usually decline an offer for a candidate if DSA are present or accept only if the DSA are felt to be "lower risk" on the basis of their mean fluorescent intensities (MFI), titers, or their cellbased crossmatch (CBCM) results. 9 However, declining donor lungs on the basis of DSA may disadvantage sensitized lung transplant

Safety of Crossing Donor-specific Antibodies in Lung Transplantation

“…Our primary survival analysis for the most part corroborates the other single-center studies on crossing DSA at time of lung transplant, but these differences are both notable. 9,10,[20][21][22][23][24] Given these are secondary findings, caution is warranted in their interpretation, and we would first need to consider that they are center-specific observations and potentially confounded by other elements. However, the PGD association in particular remained after adjustment for other PGD risk factors.…”

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

“…One group reported positive outcomes for DSA-positive patients who received TPE, plus IVIG and rituximab if allograft dysfunction occurred (Courtwright, 2019). Another published the long-term outcomes of sensitized lung transplant recipients (N = 146), showing similar rates of allograft and CLAD-free survival compared with unsensitized recipients (N = 194); sensitized recipients received a combination of pre-and post-operative TPE, IVIG, and ATG (Aversa, 2021).…”

Removing Barriers and Mitigating Risk: The Case for Crossing Donor-specific Antibodies in Lung Transplantation With the Use of Perioperative Desensitization

“…8 They report that DSA-positive lung transplant recipients have similar allograft survival and chronic lung allograft dysfunction-free survival to other lung transplant recipients, which is consistent with the prior literature. 4-7 However, they also found that DSAs at the time of transplant were associated with both severe primary graft dysfunction at 48–72 h and AMR, which has been variably reported in prior studies. 4,6,7…”