Evaluation of current strategies for surveillance and management of donor-specific antibodies: Single-center study
Evaluation of current strategies for surveillance and management of donor-specific antibodies: Single-center study
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DOI：
10.1111/ctr.13285
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发表时间：
2018-07-01
影响因子：
2.1
通讯作者：
Kaza, Vaidehi
中科院分区：
文献类型：
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作者：
Sullivan, Daniel;Ahn, Chul;Kaza, Vaidehi
背景虽然供者特异性抗体(DSA)的存在对同种异体肺移植的影响是已知的，但有关DSA处理的数据有限。方法我们在2010年1月1日至2014年6月30日期间在本中心进行了一项回顾性研究，评估接受肺移植的成人肺移植患者的DSA处理。研究跟踪工作已完成至2017年10月。根据有无DSA将所有受者分成2组。对有DSA的患者进行DSA治疗的影响评估。主要结果是肺移植后存活和免于发生闭塞性毛细支气管炎综合征(BOS)，这是慢性肺移植功能障碍(CLAD)的亚组。采用Simon-Makuch方法估计总生存期和无BOS生存期，将DSA作为时间依赖协变量。结果194名受试者中64%的患者发生了肺移植后DSA。在从未清除DSA的DSA阳性组中，总存活率不同于较差的存活率(P=0.002)。本组无BOS生存率较低，但差异无统计学意义。治疗反应差，47例接受治疗的患者中只有12例(25.5%)显示DSA清除。结论肺移植后供者特异性抗体流行率高。DSA的清除与结果的改善相关。目前针对DSA的治疗策略相对无效。将需要进行多中心合作研究，以评估当前的治疗策略和其他创新模式。
BackgroundAlthough the presence of donor-specific antibodies (DSA) is known to impact lung allograft, limited data exist regarding DSA management.MethodsWe did a retrospective study at our center evaluating DSA management in adult lung transplant recipients undergoing lung transplantation between January 1, 2010 and June 30, 2014. Study follow-up was completed through October 2017. All recipients were stratified into 2 groups based on the presence or absence of DSA. Those with DSA were evaluated for the impact of treatment of DSA. The primary outcomes were postlung transplant survival and freedom from bronchiolitis obliterans syndrome (BOS), subset of chronic lung allograft dysfunction (CLAD). Simon-Makuch method was used to estimate overall survival and BOS-free survival to account for DSA as time-dependent covariate. Survival differences between the groups were analyzed using time-dependent Cox proportional hazards model.ResultsSixty-four percent of 194 total subjects developed post-lung transplant DSA. Overall survival was different with worse survival in the DSA positive group that never cleared DSA (P=.002). BOS-free survival was lower, but did not reach significance in this group. Response to treatment was poor, with only 12 of 47 (25.5%) who received treatment demonstrating clearance of DSA.ConclusionsDonor-specific antibodies prevalence is high after lung transplantation. Clearance of DSA correlated with improved outcomes. Current therapeutic strategies against DSA are relatively ineffective. Multicenter collaborative studies will be required to evaluate current treatment strategies and other innovative modalities.