Donor-specific antibody characteristics, including persistence and complement-binding capacity, increase risk for chronic lung allograft dysfunction

J Heart Lung Transplant. 2020 Dec;39(12):1417-1425. doi: 10.1016/j.healun.2020.09.003. Epub 2020 Sep 10.

Abstract

Background: Chronic lung allograft dysfunction (CLAD) is the major complication limiting long-term survival in lung transplant recipients (LTRs), with those developing donor-specific anti-human leukocyte antigen (HLA) antibodies (DSAs) previously found to have increased risk for CLAD. However, as DSA responses vary in timing of development, specificity, breadth, persistence, and complement-binding capacity, we hypothesized that these characteristics would impact CLAD and survival outcomes.

Methods: We retrospectively analyzed DSA characteristics and outcomes in a single-center cohort of 582 LTRs who had serum samples collected prospectively from 2010 to 2016. Luminex-based single antigen bead assays were performed to assess DSA.

Results: DSAs were detected in 247 LTRs (42%), of which 124 (21.3%) were de novo DSAs and 53 (9.1%) were complement-binding (C1q+). CLAD developed in 208 LTRs (35.7%) during the follow-up period, with 67.8% determined as bronchiolitis obliterans syndrome phenotype and 32.2% as restrictive allograft syndrome phenotype. We found a shorter time to CLAD in LTRs with persistent DSAs (p = 0.04) and HLA-DQ-specific DSAs (p = 0.03). LTRs who developed C1q+ DSAs had significantly shorter time to CLAD (p < 0.001), with 100% of C1q+ DSAs being persistent and no differences between CLAD phenotypes. CLAD-free survival was significantly reduced in LTRs who developed C1q+ DSAs (p = 0.001), HLA-DQ-specific DSAs (p = 0.03), and multiple DSAs (p = 0.02).

Conclusions: Together, our findings demonstrate that DSA characteristics of persistence, HLA-DQ specificity, and C1q+ DSAs are associated with shorter time to CLAD. Additionally, C1q+, HLA-DQ-specific, and multiple DSAs are associated with decreased CLAD-free survival. These characteristics may improve DSA risk stratification for deleterious outcomes in LTRs.

Keywords: C1q; chronic lung allograft dysfunction; complement fixing antibodies; donor-specific antibody; lung transplantation.

Publication types

  • Observational Study

MeSH terms

  • Bronchiolitis Obliterans / surgery
  • Chronic Disease
  • Complement C1q / metabolism*
  • Female
  • Follow-Up Studies
  • Graft Survival
  • HLA Antigens / immunology*
  • Humans
  • Isoantibodies / immunology*
  • Lung / immunology*
  • Lung / pathology
  • Lung Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Primary Graft Dysfunction / diagnosis
  • Primary Graft Dysfunction / immunology*
  • Primary Graft Dysfunction / metabolism
  • Retrospective Studies
  • Tissue Donors
  • Transplant Recipients*
  • Transplantation, Homologous

Substances

  • HLA Antigens
  • Isoantibodies
  • Complement C1q