Abstract
Background Preformed donor-specific antibodies (DSAs) are associated with worse outcome after lung transplantation (LTx) and migvaht limit access to LTx. A virtual crossmatch (CXM)-based strategy for perioperative desensitisation protocol has been used for immunised LTx candidates since 2012 at Foch hospital. We compared the outcome of desensitised LTx candidates with high DSA mean fluorescence intensity (MFI) and those with low or no preformed DSAs, not desensitised.
Methods For all consecutive LTx recipients (January-2012/March-2018), freedom from CLAD and graft survival were assessed by Kaplan–Meier analysis and Cox multivariate analysis.
Results We compared outcomes for desensitised patients with high preformed DSAs (n=39) and those with no (n=216) or low pre-formed DSAs (n=66). The desensitisation protocol decreased the level of immunodominant DSA (class I/II) at 1, 3, and 6 month post-LTx (p<0.001, p<0.01, p<0.001, respectively). Freedom from CLAD and graft survival at 3 years was similar in the desensitised group as a whole and other groups. Nevertheless, incidence of CLAD was higher with persistent high- than cleared high-level (p=0.044) or no DSAs (p=0.014). Conversely, graft survival was better with cleared high DSAs than persistent high-, low-level, and no pre-formed DSAs (p=0.019, p=0.025, and p=0.044, respectively). On multivariate analysis, graft survival was associated with cleared high DSAs (HR: 0.12 [95%CI: 0.02–0.85] versus no DSAs, p=0.035) and CLAD with persistent DSAs (HR: 3.04 [1.02–9.17] versus no preformed DSAs, p=0.048).
Conclusion The desensitisation protocol in LTx recipients with high preformed DSAs was associated with satisfactory outcome, with cleared high pre-formed DSAs after desensitisation identified as an independent predictor of graft survival.
Footnotes
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Conflict of interest: Dr. Parquin has nothing to disclose.
Conflict of interest: Dr. Zuber has nothing to disclose.
Conflict of interest: Dr. Vallée has nothing to disclose.
Conflict of interest: Dr. Taupin has nothing to disclose.
Conflict of interest: Dr. Cuquemelle has nothing to disclose.
Conflict of interest: Dr. MALARD has nothing to disclose.
Conflict of interest: Dr. NEUVILLE has nothing to disclose.
Conflict of interest: Dr. devaquet has nothing to disclose.
Conflict of interest: Dr. Le Guen has nothing to disclose.
Conflict of interest: Dr. Fessler has nothing to disclose.
Conflict of interest: Dr. Beaumont has nothing to disclose.
Conflict of interest: Dr. Picard has nothing to disclose.
Conflict of interest: Dr. Hamid has nothing to disclose.
Conflict of interest: Dr. Colin de Verdière has nothing to disclose.
Conflict of interest: Dr. Grenet has nothing to disclose.
Conflict of interest: Dr. de miranda has nothing to disclose.
Conflict of interest: Dr. Glorion has nothing to disclose.
Conflict of interest: Dr. SAGE has nothing to disclose.
Conflict of interest: Dr. Pricopi has nothing to disclose.
Conflict of interest: Dr. De Wolf has nothing to disclose.
Conflict of interest: Dr. BRUN has nothing to disclose.
Conflict of interest: Dr. LONGCHAMPT has nothing to disclose.
Conflict of interest: Dr. Cerf has nothing to disclose.
Conflict of interest: Dr. Roux has nothing to disclose.
Conflict of interest: Dr. Brugière has nothing to disclose.
- Received November 17, 2020.
- Accepted April 7, 2021.
- Copyright ©The authors 2021. For reproduction rights and permissions contact permissions{at}ersnet.org