Safety of Crossing Donor-specific Antibodies in Lung Transplantation

Abstract

participated in developing the study and preparing the article. D.L. helped in collecting data and performing the analyses. K.H. developed the study, performed the main analyses, and wrote the final draft of the article.The data that support these analyses can be made available on reasonable request to the corresponding author (K.H.).

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

“…6,7 As expected, the interquartile range of MFI of the DSAs included in this study and in the Toronto study was larger than that in the BWH and Foch studies. 4,[6][7][8] Although MFI as a measure of DSA strength is semiquantitative at best and cannot necessarily be compared directly between centers, 9 the inclusion of DSAs of MFI as high as 11 987 in this study at least indicates that higher immunological risk DSAs may also be crossed safely at the time of transplant with perioperative desensitization. 8 Second, plasmapheresis was initiated postoperatively for DSA-positive transplants in this study, 8 which differs from the Toronto study (started intraoperatively) 4 and the Foch study (started preoperatively).…”

“…4,[6][7][8] Although MFI as a measure of DSA strength is semiquantitative at best and cannot necessarily be compared directly between centers, 9 the inclusion of DSAs of MFI as high as 11 987 in this study at least indicates that higher immunological risk DSAs may also be crossed safely at the time of transplant with perioperative desensitization. 8 Second, plasmapheresis was initiated postoperatively for DSA-positive transplants in this study, 8 which differs from the Toronto study (started intraoperatively) 4 and the Foch study (started preoperatively). 7 The concerns expressed by Wang et al for increased bleeding with intraoperative www.transplantjournal.com plasmapheresis 8 are shared by many programs and are currently a significant barrier to more programs accepting DSA-positive transplants.…”

“…Second, plasmapheresis was initiated postoperatively for DSA-positive transplants in this study, 8 which differs from the Toronto study (started intraoperatively) 4 and the Foch study (started preoperatively). 7 The concerns expressed by Wang et al for increased bleeding with intraoperative plasmapheresis 8 are shared by many programs and are currently a significant barrier to more programs accepting DSA-positive transplants. 1 The fact that the outcomes of this study 8 are aligned with others that used intraoperative 4 and preoperative plasmapheresis 7 for DSA-positive lung transplants indicates that the timing of plasmapheresis may be modified safely.…”

“…As were the prior studies, [4][5][6][7] this study is also limited by its observational, retrospective, and single-center nature. 8 As an increasing number of programs have liberalized their acceptance of crossing DSAs at the time of transplant, we now have the opportunity to compare outcomes of our various protocols for accepting and managing these types of transplants. A multicenter study is necessary to better address our knowledge gaps pertaining to "high-risk DSA" and the most effective perioperative desensitization regimen to use when DSAs are present so more sensitized candidates can benefit from increased access to lung transplants.…”

“…First, in this study, DSA-positive lung transplants were accepted regardless of the mean fluorescence intensity (MFI) of the DSA or the results of the cell-based crossmatch. 8 The Toronto program also accepted the crossing of DSAs regardless of MFI and without a prospective cell-based crossmatch, 4 but the BWH and Foch programs excluded DSA-positive transplants if the CDCXM was positive or if the MFI of the DSAs exceeded 5000. 6,7 As expected, the interquartile range of MFI of the DSAs included in this study and in the Toronto study was larger than that in the BWH and Foch studies.…”