title: Impact of pretransplant anti-HLA antibodies on outcomes in lung transplant candidates.
abstract: BACKGROUND
  The prevalence of anti-HLA antibodies in lung transplant candidates and their impact on waitlist and transplant outcomes is not known.
  
  
  OBJECTIVE
  We examined the prevalence of pretransplant anti-HLA antibodies at varying thresholds and evaluated their impact on outcomes before and after lung transplantation.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Among 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).
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: 1 Heart Transplant Program, Center for Advanced Heart Disease, Department of Medicine.
authors.forename: Miae
authors.initials: M
authors.lastname: Kim
authors.forename: Keri R
authors.initials: KR
authors.lastname: Townsend
authors.forename: Isabelle G
authors.initials: IG
authors.lastname: Wood
authors.forename: Steve
authors.initials: S
authors.lastname: Boukedes
authors.forename: Indira
authors.initials: I
authors.lastname: Guleria
authors.forename: Steven
authors.initials: S
authors.lastname: Gabardi
authors.forename: Souheil
authors.initials: S
authors.lastname: El-Chemaly
authors.forename: Phillip C
authors.initials: PC
authors.lastname: Camp
authors.forename: Anil K
authors.initials: AK
authors.lastname: Chandraker
authors.forename: Edgar L
authors.initials: EL
authors.lastname: Milford
authors.forename: Hilary J
authors.initials: HJ
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000401:mortality; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000097:blood*; D006650:Histocompatibility Testing; D006801:Humans; D007155:Immunologic Factors / Q000097:blood*; D007518:Isoantibodies / Q000097:blood*; D016040:Lung Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006680:HLA Antigens; D007155:Immunologic Factors; D007518:Isoantibodies