Zentralbl Chir 2018; 143(S 01): S100
DOI: 10.1055/s-0038-1668390
Freie Vorträge
Georg Thieme Verlag KG Stuttgart · New York

Influence of Antibodies against HLA DQA/DP to Chronic Lung Allograft Dysfunction

JR Hermawan
1   München
,
H Winter
2   Department of Thoracic Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich
,
L Strakeljahn
2   Department of Thoracic Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich
,
M Schmitzer
2   Department of Thoracic Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich
,
A Dick
3   Laboratory for Immunogenetics, Department of Transfusion Medicine, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich
,
N Kneidinger
4   Department of Internal Medicine V, Comprehensive Pneumology Center Munich (CPC-M); Member of the German Center for Lung Research (DZL)
,
R Schramm
5   Department of Cardiac Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich
,
V von Dossow
6   Department of Anaesthesiology, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich. Munich Lung Transplant Group (MLTP)
,
C Schneider
2   Department of Thoracic Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich
,
G Preissler
2   Department of Thoracic Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich
,
RA Hatz
2   Department of Thoracic Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich
,
T Kauke
7   Department of Thoracic Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University; Laboratory for Immunogenetics, Department of Transfusion Medicine, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich
› Author Affiliations
Further Information

Publication History

Publication Date:
05 September 2018 (online)

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    Background:

    In recent studies de novo donorspecific HLA-antibodies (DSA) particularly against HLA-DQB were suspected to contribute to chronic lung allograft dysfunction (CLAD). However, the role of Anti-HLA-DQA/DP is completely unknown.

    Methods:

    The presence of HLA-antibodies was examined prospectively on 224 lung patients, who were transplanted between 2013 – 2017. HLA-antibodies were investigated by Single Antigen Bead assay prior and 1, 3, 6, 12, 18, 24 and 36 months after transplantation. We compared patient survival and the development of BOS (bronchiolitis obliterans syndrome) in 118 patients with and without Anti-DQA/DP, who had at least a follow up time of 24 months.

    Results:

    In 60 out of 118 (50.8%) patients HLA-antibodies were not detectable. Anti-HLA Class I (A, B, C) and/or II (DRB, DQB) were found in 28 (23.7%) patients, and 30 (25.4%) patients had additionally Anti-HLA DQA/DP.

    During the first two years after transplantation, 46 (39%) patients developed de novo DSA. In 21 out of 46 (45.7%) patients DSA were persistently detectable. In 25 (52.2%) patients the DSA disappeared and were classified as transient.

    There was no statistical difference between the 2 year survival of patients without and with HLA-antibodies but patients with additional Anti-DQA/DP had the poorest survival (82.5%, 85.1%, 69.7%, p = 0,269). Patients with additional Anti-DQA/DP showed also a higher risk to develop BOS (16.7%, 26.9%, 42.3%, p = 0,047). A higher incidence of BOS was also noticed in the DSA group compared to the non DSA group (36.6%, 18.5%, p = 0,037). The highest mortality two years after transplantation was observed in patients with persistent DSA in comparison to patients with transient DSA (56.4%, 91.5%, p = 0,005).

    Conclusion:

    The additional presence of Anti-HLA DQA/DP increases the risk of developing CLAD. Patient survival was poorer if the HLA antibodies persisted and were donor-specific. Therefore, Anti-DQA/DP should be taken into consideration during regular HLA-antibody monitoring after lung transplantation.


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