Lung transplant patients with persistent donor-specific antibodies (DSAs) may be more likely to develop restrictive chronic lung allograft dysfunction or restrictive allograft syndrome than patients who experience transient DSAs, according to a new study published in the ERJ.
Researchers assessed the association between human leukocyte antigen (HLA) antibodies and CLAD-free and graft survival in a cohort of 362 patients, and stratified analysis according to DSA status, persistence of antibodies and timing of antibodies (pre-transplant, early or late post-transplant).
17% of patients developed DSAs; this was found to be associated with worse CLAD-free and graft survival. Both persistent and transient DSAs were associated with shorter CLAD-free survival compared with patients without DSAs.
Persistent DSAs, but not transient DSAs, were negatively associated with graft survival compared with patients without DSAs; the authors state this is likely due to a higher incidence of restrictive
CLAD.
The authors conclude that transplant patients with persistent DSAs tend to have the worst outcomes as they frequently develop RAS, and state that persistent HLA non-DSAs or pre-transplant HLA antibodies did not impact long-term outcome.