Clinical Implications of Early vs Late Development of Donor-Specific Antibodies Among Lung Transplant Recipients: A...

Lung transplant recipients (LTRs) can develop donor-specific antibodies (DSAs), which are associated with antibody-mediated rejection (AMR). LTRs at our center undergo regular DSA surveillance in the first year after lung transplant (LT), and LTRs that develop DSAs are treated, even in the absence of allograft dysfunction. We compared the clinical outcomes of LTRs without DSAs to those of LTRs that developed DSAs early after LT (< 3 months) or late after LT (3-12 months).

We retrospectively analyzed 428 LTRs transplanted at our center between February 2017 and June 2022. Of these, 94 were included in the no-DSA group (mean fluorescence intensity [MFI] < 500) and 143 were included in the DSA groups (MFI ≥ 2000), with 131 in the early-DSA group and 12 in the late-DSA group. We compared the groups using Fisher's exact test, the median test, and Kaplan-Meier and Cox regression survival analyses.

There was no statistically significant difference in 1- and 3-year survival between the 3 groups; however, 3-year survival in the late-DSA group was 33%, with AMR as the cause of death in 2 of the 4 deceased LTRs. DSAs declined in the majority of patients in both the early and late groups. There were no significant differences in infectious complications between the groups (p = 0.332).

LTRs with early DSAs and preemptive treatment have a good prognosis, with post-LT overall survival and chronic lung allograft dysfunction (CLAD)-free survival comparable to that of LTRs without DSAs. LTRs with late DSAs may have worse long-term and CLAD-free survival; however, larger studies are needed.