title: The Presence of Pretransplant HLA Antibodies Does Not Impact the Development of Chronic Lung Allograft Dysfunction or CLAD-Related Death.
abstract: Development of donor-specific antibodies (DSA) after lung transplantation is associated with antibody mediated rejection, acute cellular rejection, and bronchiolitis obliterans syndrome; however, the significance of circulating antibodies before transplant remains unclear.
  
  
  
  We performed a retrospective cohort study including recipients of primary lung transplants between 2008 and 2012. We assessed the impact of circulating HLA and noncytotoxic DSA detected before transplant on development of Chronic Lung Allograft Dysfunction (CLAD) or CLAD-related death.
  
  
  
  30% of subjects had circulating class I antibodies alone, 4% Class II, and 14.4% class I and class II at mean fluorescent intensity greater than 1000. Nine percent of the subjects had DSA class I, 9% class II, and 2.4% both DSA classes 1 and 2. Neither the presence of circulating antibodies (adjusted hazard ratio, 0.87; 95% confidence interval, 0.50-1.54) nor the presence of DSA (adjusted hazard ratio, 1.56; 95% confidence interval, 0.77-3.18) before transplant at mean fluorescent intensity greater than 1000 was associated with the development of CLAD or CLAD-related death.
  
  
  
  Although in previous studies we have shown an increased incidence of antibody-mediated rejection in patients with pretransplant DSA, neither the presence of HLA antibodies nor DSA translated to an increased risk of allograft dysfunction or death if prospective crossmatch testing was negative. Prospective studies are needed to define the impact of pretransplant sensitization on lung transplant recipients.
authors.affiliation: 1 Lung Transplant Program, Pulmonary and Critical Care Medicine Division, Brigham and Women's Hospital, Boston, MA. 2 Heart Transplant Program, Center for Advanced Heart Disease, Division of Cardiology, Brigham and Women's Hospital, Boston, MA. 3 Department of Pharmacy, Brigham and Women's Hospital, Boston, MA. 4 Clinical Laboratory Division, Tissue Typing Laboratory, Brigham and Women's Hospital, Boston, MA. 5 Harvard Medical School, Boston, MA. 6 Renal Transplant Program, Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA. 7 Lung Transplant Program, Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Oscar E
authors.initials: OE
authors.lastname: Zazueta
authors.forename: Sara E
authors.initials: SE
authors.lastname: Preston
authors.forename: Anna
authors.initials: A
authors.lastname: Moniodis
authors.forename: Sabrina
authors.initials: S
authors.lastname: Fried
authors.forename: Miae
authors.initials: M
authors.lastname: Kim
authors.forename: Keri
authors.initials: K
authors.lastname: Townsend
authors.forename: Isabelle
authors.initials: I
authors.lastname: Wood
authors.forename: Steve
authors.initials: S
authors.lastname: Boukedes
authors.forename: Indira
authors.initials: I
authors.lastname: Guleria
authors.forename: Phillip
authors.initials: P
authors.lastname: Camp
authors.forename: Souheil
authors.initials: S
authors.lastname: El-Chemaly
authors.forename: Ivan O
authors.initials: IO
authors.lastname: Rosas
authors.forename: Anil
authors.initials: A
authors.lastname: Chandraker
authors.forename: Edgar
authors.initials: E
authors.lastname: Milford
authors.forename: Hilary J
authors.initials: HJ
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D002908:Chronic Disease; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D008171:Lung Diseases / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies