Impact for Survival and Chronic Lung Allograft Dysfunction of ISHLT Consensus of Antibody Mediated Rejection after Lung Transplantation

Abstract

Purpose Antibody-mediated rejection (AMR) affects survival and incidence of chronic lung allograft dysfunction (CLAD) after lung transplantation, however, the impact has not been adequately assessed. The aim of this study was to investigate the survival of AMR patients based on new criteria established by International Society of Heart and Lung Transplantation (ISHLT) committee and to assess the risk ratio for CLAD including bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). Methods We performed a retrospective, single center cohort study and identified cases who developed AMR based on the new ISHLT-criteria. Risk factors including AMR as a time varying covariate for death and incidence of CLAD were assessed with multivariate analysis. Results Between Jan 2012 and Dec 2016, 489 adult lung transplants were performed. Follow up was completed through Jun 2018. The mean ± SD of age was 58 ± 13 yo, and there were 140 (29%) females. Mean overall follow-up time was 3.5 ± 1.5 years. There were 328 cases with AMR (clinical definite, 4; clinical probable, 29; clinical possible, 26; subclinical definite, 3; subclinical probable, 47; subclinical possible 219). Class II donor specific antibodies (DSA) (hazard ratio; 3.64 ± 0.29, p Conclusion Our study demonstrated that subclinical, definite, probable or possible AMR did not significantly associated with death or CLAD after lung transplantation, although clinical AMR independently affected transplant survival and incidence of CLAD. Further study is necessary to investigate the reliability of the criteria.