title: Preemptive treatment with therapeutic plasma exchange and rituximab for early donor-specific antibodies after lung transplantation.
abstract: OBJECTIVE
  De novo donor-specific anti-human leukocyte antigen antibodies develop in a high proportion of lung transplant recipients early after lung transplantation. We recently showed that de novo donor-specific antibodies (DSA) occurrence is associated with significantly increased mortality. Here, we studied the efficacy of a preemptive treatment protocol.
  
  
  METHODS
  A retrospective observational study was conducted on all lung transplantations at Hanover Medical School between January 2009 and May 2013.
  
  
  RESULTS
  Among the 500 transplant recipients, early DSA developed in 86 (17%). Of these, 56 patients (65%; Group A) received therapeutic plasma exchange, and 30 patients (35%; Group B) did not. Among Group A patients, 51 also received rituximab. Between groups, there was no statistically significant difference in mortality, incidence of pulsed steroid therapies, rejections diagnosed by biopsy specimen, incidence of bronchitis obliterans syndrome (BOS), or infections requiring hospitalization at 1 year and 3 years. Also, there were no statistically significant differences after matching 21 Group A with 21 Group B patients through propensity score analysis. Significantly more Group A patients (65%) than Group B patients (34%) cleared DSA at hospital discharge (p = 0.01). At the last control after transplantation (median, 14 months; interquartile range, 5-24 months), 11 Group A (22%) and 9 Group B patients (33%) still showed DSA (p = 0.28).
  
  
  CONCLUSIONS
  Preemptive treatment with therapeutic plasma exchange and rituximab led to improved elimination of DSA early after lung transplantation (p = 0.01). However, spontaneous elimination in untreated Group B patients also occurred frequently. This treatment protocol was not associated with significantly improved outcome.
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ius
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
authors.forename: Wiebke
authors.initials: W
authors.lastname: Sommer
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
authors.forename: Igor
authors.initials: I
authors.lastname: Tudorache
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Kühn
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
authors.forename: Murat
authors.initials: M
authors.lastname: Avsar
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
authors.forename: Thierry
authors.initials: T
authors.lastname: Siemeni
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
authors.forename: Jawad
authors.initials: J
authors.lastname: Salman
authors.affiliation: Department of Transfusion Medicine, Hanover Medical School, Hanover, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hallensleben
authors.affiliation: Department of Transfusion Medicine, Hanover Medical School, Hanover, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Kieneke
authors.affiliation: Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Greer
authors.affiliation: Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Gottlieb
authors.affiliation: Department of Hypertension and Nephrology, Hanover Medical School, Hanover, Germany.
authors.forename: Jan T
authors.initials: JT
authors.lastname: Kielstein
authors.affiliation: Paediatric Cardiology, Hanover Medical School, Hanover, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Boethig
authors.affiliation: Department of Respiratory Medicine, Hanover Medical School, Hanover, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany. Electronic address: warnecke.gregor@mh-hannover.de.
authors.forename: Gregor
authors.initials: G
authors.lastname: Warnecke
mesh_terms: D000328:Adult; D000906:Antibodies / Q000276:immunology*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D018951:Antigens, CD20; D005260:Female; D005858:Germany / Q000453:epidemiology; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology* / Q000628:therapy; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D015994:Incidence; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000379:methods*; D012189:Retrospective Studies; D000069283:Rituximab; D015996:Survival Rate / Q000639:trends; D014019:Tissue Donors
chemical_list: D000906:Antibodies; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D006680:HLA Antigens; D007155:Immunologic Factors; D000069283:Rituximab
keywords: death; donor-specific antibodies; human leukocyte antigen; lung transplant; preemptive treatment; therapeutic plasma exchange