American Transplant Congress
May 5-9 2007
Abstract Number: 952667
Keyword 1: Alloantibodies Keyword 2: Lung transplantation Keyword 3: Rejection
Abstract Title: THE INCIDENCE, IMPACT, AND MANAGEMENT OF HUMORAL
REJECTION IN LUNG TRANSPLANTATION
Tarik Haddad, MD1, Ramesh Kesavan, MD1, Gnananandh Jayaraman, MD1, Yavuz Silay,
MD1, George Noon, MD1, Matthias Loebe, MD1, Osama Gaber, MD2, Nadine Haykal2, Said
Soubra, MD1, Charlie Lan, DO1, Phillip Cagle, MD2, Anna Sienko, MD2, Roberto Barrios,
MD2 and Harish Seethamraju, MD1. 1Pulmonary and Critical Care, Baylor College of
Medicine, Houston, TX, United States and 2Pathology, Methodist Hospital, Houston, TX,
United States.
Body: Humoral rejection is associated with graft dysfunction in lung transplantation. We
sought to determine the associated risk factors for the development of donor specific
antibodies (DSA), use of c4d staining in detection for humoral rejection, and whether
treatment of these patients results in graft improvement.
During the period from January 2004 through June 2006, our center performed 55 lung
transplants. A longitudinal prospective study was performed on these patients identifying
the presence of panel reactive antibodies (PRA), DSA, and their associated risk factors. Of
the identified group, patients with graft dysfunction marked by the presence of decreased
spirometry values, dyspnea, or capillaritis underwent transbronchial biopsy with c4d
staining by immunofluorescence. Patients identified with humoral rejection defined by
presence of positive C4d staining, presence of DSA, and graft dysfunction underwent
treatment with plasmapheresis, IVIG and rituximab.
19 post lung transplant patients with new elevations in PRA with either T or B cell class
specificities or DSA with graft dysfunction were compared to patients without PRA and
preserved graft function. There was no difference in the average age, race, transplant type,
CMV status. Increased PRA post lung transplant was seen in female patients, use of
cardiopulmonary bypass, and increased ventilator days. Within the positive PRA group, a
subgroup was identified in which there was positive C4d staining (n=10). These two
subgroups compared similarly with respect to age, sex, race, blood type, and CMV status.
There was also increased presence of donor specific antibodies (7/10). Treatment for
humoral rejection was performed in 4 patients. A significant improvement in FEV1 was
seen in three patients with increases of FEV1 of 330cc, 290cc, and 100cc. One patient had
resolution of PRA with treatment. It is too early to determine a similar response with the
other patients.
Humoral rejection is an important cause of graft dysfunction in lung transplant recipients.
Risk factors such as female sex, use of cardiopulmonary bypass, and increased ventilator
days were associated with increased PRA. Treatment of humoral rejection is associated
with improvement in graft function.