Panel-Reactive and Donor-Specific Antibodies before Lung Transplantation can Affect Outcomes in Korean Patients Receiving Lung Transplantation
10.3349/ymj.2020.61.7.606
- Author:
Sung Woo MOON
1
;
Moo Suk PARK
;
Jin Gu LEE
;
Hyo Chae PAIK
;
Young Tae KIM
;
Hyun Joo LEE
;
Samina PARK
;
Sun Mi CHOI
;
Do Hyung KIM
;
Woo Hyun CHO
;
Hye Ju YEO
;
Seung-il PARK
;
Se Hoon CHOI
;
Sang-Bum HONG
;
Tae Sun SHIM
;
Kyung-Wook JO
;
Kyeongman JEON
;
Byeong-Ho JEONG
;
Song Yee KIM
;
Author Information
1. Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Publication Type:Original Article
- From:Yonsei Medical Journal
2020;61(7):606-613
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:Data on the distribution and impact of panel reactive antibodies (PRA) and donor specific antibodies (DSA) before lung transplantation in Asia, especially multi-center-based data, are limited. This study evaluated the prevalence of and effects of PRA and DSA levels before lung transplantations on outcomes in Korean patients using nationwide multicenter registry data.
Materials and Methods:This study included 103 patients who received a lung transplant at five tertiary hospitals in South Korea between March 2015 and December 2017. Mortality, primary graft dysfunction (PGD), and bronchiolitis obliterans syndrome (BOS) were evaluated.
Results:Sixteen patients had class I and/or class II PRAs exceeding 50%. Ten patients (9.7%) had DSAs with a mean fluorescence intensity (MFI) higher than 1000, six of whom had antibodies with a high MFI (≥2000). DSAs with high MFIs were more frequently observed in patients with high-grade PGD (≥2) than in those with no or low-grade (≤1) PGD. In the 47 patients who survived for longer than 9 months and were evaluated for BOS after the transplant, BOS was not related to DSA or PRA levels. One-year mortality was more strongly related to PRA class I exceeding 50% than that under 50% (0% vs. 16.7%, p=0.007).
Conclusion:Preoperative DSAs and PRAs are related to worse outcomes after lung transplantation. DSAs and PRAs should be considered when selecting lung transplant recipients, and recipients who have preoperative DSAs with high MFI values and high PRA levels should be monitored closely after lung transplantation.
