title: Early donor-specific antibodies in lung transplantation: risk factors and impact on survival.
abstract: BACKGROUND
  The impact of early donor-specific anti-HLA antibodies (DSA) on patient and graft survival after lung transplantation remains controversial. In this study we analyzed risk factors for DSA that developed before initial hospital discharge after lung transplantation (early DSA) and compared mid-term outcomes in patients with or without DSA.
  
  
  METHODS
  Between January 2009 and August 2013, 546 patients underwent lung transplantation at our institution. One hundred (18%) patients developed early DSA (Group A) and 446 (82%) patients (Group B) did not. Patient records were retrospectively reviewed.
  
  
  RESULTS
  Retransplantation (odds ratio [OR] = 2.7, 95% confidence interval [CI] 1.1 to 6.5, p = 0.03), pre-operative HLA antibodies (OR = 2.1, 95% CI 1.2 to 3.4, p = 0.003) and primary graft dysfunction (PGD) score Grade 2 or 3 at 48 hours (OR = 2.6, 95% CI 1.5 to 4.6, p = 0.001) were associated with early DSA development. Overall, 1- and 3-year survival in Group A and B patients was 79 ± 4% vs 88 ± 2% and 57 ± 8% vs 74 ± 3%, respectively (p = 0.019). Eleven Group A (11%) and 32 Group B (7%) patients died before hospital discharge (p = 0.34). Among patients surviving beyond discharge, 1- and 3-year survival in Group A and B patients was 89 ± 4% vs 95 ± 1% and 65 ± 8% vs 80 ± 3% in Group A and B patients, respectively (p = 0.04). Multivariate analysis identified early anti-HLA Class II DSA (OR = 1.9, 95% CI 1.0 to 3.4, p = 0.04) as an independent risk factor for post-discharge mortality but not for in-hospital mortality.
  
  
  CONCLUSIONS
  Pre-operative HLA antibodies, retransplantation or post-operative PGD increase the risk of developing early DSA, which were independently associated with an increased risk for mortality.
authors: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover.
authors: Fabio
authors: F
authors: Ius
authors: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover; German Centre for Lung Research, Hannover.
authors: Wiebke
authors: W
authors: Sommer
authors: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover.
authors: Igor
authors: I
authors: Tudorache
authors: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover.
authors: Christian
authors: C
authors: Kühn
authors: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover.
authors: Murat
authors: M
authors: Avsar
authors: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover.
authors: Thierry
authors: T
authors: Siemeni
authors: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover.
authors: Jawad
authors: J
authors: Salman
authors: Department of Transfusion Medicine, Hannover Medical School, Hannover, Germany.
authors: Michael
authors: M
authors: Hallensleben
authors: Department of Transfusion Medicine, Hannover Medical School, Hannover, Germany.
authors: Daniela
authors: D
authors: Kieneke
authors: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors: Mark
authors: M
authors: Greer
authors: German Centre for Lung Research, Hannover; Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors: Jens
authors: J
authors: Gottlieb
authors: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover; German Centre for Lung Research, Hannover.
authors: Axel
authors: A
authors: Haverich
authors: Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover; German Centre for Lung Research, Hannover. Electronic address: warnecke.gregor@mh-hannover.de.
authors: Gregor
authors: G
authors: Warnecke
mesh_terms: D000328:Adult; D000888:Antibodies, Anti-Idiotypic / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology / Q000401:mortality; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D008168:Lung / Q000276:immunology*; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D000888:Antibodies, Anti-Idiotypic; D006680:HLA Antigens
keywords: BOS; acute rejection; donor specific HLA antibodies; lung transplantation; risk factors; survival