title: Lung transplantation in patients with pretransplantation donor-specific antibodies detected by Luminex assay.
abstract: BACKGROUND
  New methods of solid-phase assays, such as Luminex assay, with high sensitivity in detecting anti-human leukocyte antigen (HLA) antibodies (Abs), have increased the proportion of sensitized candidates waiting for lung transplantation (LTx). However, how to apply these results clinically during graft allocation is debated: strict exclusion of candidates with Luminex-positive results can lead to lost opportunities for Tx. We retrospectively analyzed the clinical impact of pre-LTx Luminex-detected Abs on post-LTx outcomes for patients who underwent LTx before the availability of Luminex assay.
  
  
  METHODS
  We analyzed data for 56 successive patients who underwent LTx before 2008 and were considered to not have anti-HLA Abs by then-available methods of detection at the date of their LTx. Pre-LTx sera from these patients were retested by Luminex assay. Using log-rank test, freedom from bronchiolitis obliterans syndrome (BOS) and graft survival were compared between patients with and without pre-LTx Luminex-detected anti-HLA Abs classes I and II and donor-specific Abs (DSA) classes I and II.
  
  
  RESULTS
  Freedom from bronchiolitis obliterans syndrome was lower, and mortality was higher for patients with than those without pre-LTx Luminex-detected DSA class II (P=0.004 and P=0.007, respectively) but did not differ for patients with and without DSA class I or anti-HLA Abs class I or II.
  
  
  CONCLUSIONS
  It suggests to avoid attributing graft with forbidden antigens to sensitized candidates with Luminex-detected DSA class II and to evaluate the role of specific posttransplantation protocols for LTx candidates who require emergency LTx.
authors.affiliation: Service de Pneumologie B et Transplantation Pulmonaire, Hôpital Bichat, Paris, France. olivier.brugie`re@bch.aphp.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Brugière
authors.forename: Caroline
authors.initials: C
authors.lastname: Suberbielle
authors.forename: Gabriel
authors.initials: G
authors.lastname: Thabut
authors.forename: Elodie
authors.initials: E
authors.lastname: Lhuillier
authors.forename: Gaelle
authors.initials: G
authors.lastname: Dauriat
authors.forename: Anne-Cecile
authors.initials: AC
authors.lastname: Metivier
authors.forename: Chantal
authors.initials: C
authors.lastname: Gautreau
authors.forename: Dominique
authors.initials: D
authors.lastname: Charron
authors.forename: Herve
authors.initials: H
authors.lastname: Mal
authors.forename: François
authors.initials: F
authors.lastname: Parquin
authors.forename: Marc
authors.initials: M
authors.lastname: Stern
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies