title: Comparative analysis of how immune sensitization is defined prior to lung transplantation.
abstract: BACKGROUND
  Immune sensitization prior to lung transplantation may be associated with worse survival. Using solid phase assays to define sensitization, we assessed the relationship between PRA status, donor specific anti-HLA antibodies (DSA) pre-transplant, cytotoxic cross match results and the clinical outcomes following lung transplantation.
  
  
  METHODS
  Luminex assays determined the presence of antibodies to class I and class II MHC molecules prior to lung transplantation. At the time of transplant, the PRA status, the presence of DSA and prospective cytotoxic cross match result were analysed in 195 patients undergoing lung transplantation between June 2008 and June 2012. Clinical outcomes analysed included acute cellular and antibody-mediated rejection, chronic lung allograft dysfunction (CLAD) and mortality.
  
  
  RESULTS
  At the time of transplant, 45% of patients had a positive PRA and 29% had DSA. On univariate analysis, the presence of pre-transplant class I or II anti-HLA donor-specific antibodies was not associated with the development of chronic lung allograft dysfunction (CLAD) despite significant associations with PRA status and B-cell crossmatch.
  
  
  CONCLUSIONS
  Defining sensitization using solid phase assays provide additional details regarding donor-specific sensitization but did not provide additional prognostic information to that provided by historically available cell-based cross-match assays.
authors.affiliation: Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Vic 3181, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Chin
authors.affiliation: Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Vic 3181, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Paraskeva
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Vic 3181, Australia; Clinical Haematology Department, The Alfred Hospital, Melbourne, Vic 3181, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Paul
authors.affiliation: National Transplant Services, Australian Red Cross Blood Services, Melbourne, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Cantwell
authors.affiliation: Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Vic 3181, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Levvey
authors.affiliation: Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Vic 3181, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Williams
authors.affiliation: Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Vic 3181, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Snell
authors.affiliation: Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Vic 3181, Australia. Electronic address: G.Westall@alfred.org.au.
authors.forename: G
authors.initials: G
authors.lastname: Westall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood; D002648:Child; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D006085:Graft Survival; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality / Q000601:surgery; D007114:Immunization; D016015:Logistic Models; D008168:Lung / Q000276:immunology / Q000473:pathology / Q000601:surgery; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis; D014184:Transplantation, Homologous
chemical_list: D000906:Antibodies; D006680:HLA Antigens
keywords: DSA; HLA sensitization; Lung transplantation; Outcomes; PRA