• Miae Kim, Keri R Townsend, Isabelle G Wood, Steve Boukedes, Indira Guleria, Steven Gabardi, Souheil El-Chemaly, Phillip C Camp, Anil K Chandraker, Edgar L Milford, and Hilary J Goldberg.
• 1 Heart Transplant Program, Center for Advanced Heart Disease, Department of Medicine.
• Am. J. Respir. Crit. Care Med.. 2014 May 15;189(10):1234-9.

RationaleThe prevalence of anti-HLA antibodies in lung transplant candidates and their impact on waitlist and transplant outcomes is not known.ObjectivesWe examined the prevalence of pretransplant anti-HLA antibodies at varying thresholds and evaluated their impact on outcomes before and after lung transplantation.MethodsWe performed a single-center retrospective cohort study including all patients listed for lung transplantation between January 2008 and August 2012. Per protocol, transplant candidates were assessed by solid phase LABscreen mixed Class I and II and LABscreen Single Antigen assays.Measurements And Main ResultsAmong 224 patients, 34% had anti-HLA antibodies at mean fluorescent intensity (MFI) greater than or equal to 3,000 (group III), and 24% had antibodies at MFI 1,000 to 3,000 (group II). Ninety percent of the patients with pretransplant anti-HLA antibodies had class I antibodies, whereas only seven patients developed class II alone. Patients in group III were less likely to receive transplants than patients without any anti-HLA antibodies (group I) (45.5 vs. 67.7%, P = 0.005). Wait time to transplant was longer in group III than group I, although this difference did not meet statistical significance, and waitlist mortality was similar. Among transplant recipients, antibody-mediated rejection (AMR) was more frequent in group III than in group II (20% vs. 0%, P = 0.01) or group I (6.3%, P = 0.05).ConclusionsThe presence of anti-HLA antibodies at the high MFI threshold (>3,000) was associated with lower transplant rate and higher rates of AMR. Screening for anti-HLA antibodies using the 3,000 MFI threshold may be important in managing transplant candidates and recipients.

40 keywords...

hide…