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Panel-Reactive and Donor-Specific Antibodies before Lung Transplantation can Affect Outcomes in Korean Patients Receiving Lung Transplantation

Yonsei Medical Journal 2020년 61권 7호 p.606 ~ 613
문성우 ( Moon Sung-Woo ) - Yonsei University College of Medicine Department of Internal Medicine

박무석 ( Park Moo-Suk ) - Yonsei University College of Medicine Department of Internal Medicine
이진구 ( Lee Jin-Gu ) - Yonsei University College of Medicine Severance Hospital Department of Thoracic and Cardiovascular Surgery
백효채 ( Paik Hyo-Chae ) - Yonsei University College of Medicine Severance Hospital Department of Thoracic and Cardiovascular Surgery
김영태 ( Kim Young-Tae ) - Seoul National University College of Medicine Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
이현주 ( Lee Hyun-Joo ) - Seoul National University College of Medicine Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
박사마리아 ( Park Samina ) - Seoul National University College of Medicine Seoul National University Hospital Department of Thoracic and Cardiovascular Surgery
최선미 ( Choi Sun-Mi ) - Seoul National University College of Medicine Seoul National University Hospital Department of Internal Medicine
김도형 ( Kim Do-Hyung ) - Pusan National University Yangsan Hospital Department of Thoracic and Cardiovascular Surgery
조우현 ( Cho Woo-Hyun ) - Pusan National University Yangsan Hospital Department of Pulmonology and Critical Care Medicine
여혜주 ( Yeo Hye-Ju ) - Pusan National University Yangsan Hospital Department of Pulmonology and Critical Care Medicine
박성일 ( Park Seung-Il ) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
최세훈 ( Choi Se-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Thoracic and Cardiovascular Surgery
홍상범 ( Hong Sang-Bum ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
심태선 ( Shim Tae-Sun ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
조경욱 ( Jo Kyung-Wook ) - University of Ulsan College of Medicine Asan Medical Center Department of Pulmonary and Critical Care Medicine
전경만 ( Jeon Kyeong-Man ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
정병호 ( Jeong Byeong-Ho ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
김송이 ( Kim Song-Yee ) - Yonsei University College of Medicine Department of Internal Medicine

Abstract


Purpose: Data on the distribution and impact of panel reactive antibodies (PRA) and donor specific antibodies (DSA) before lung transplantation in Asia, especially multi-center-based data, are limited. This study evaluated the prevalence of and effects of PRA and DSA levels before lung transplantations on outcomes in Korean patients using nationwide multicenter registry data.

Materials and Methods: This study included 103 patients who received a lung transplant at five tertiary hospitals in South Korea between March 2015 and December 2017. Mortality, primary graft dysfunction (PGD), and bronchiolitis obliterans syndrome (BOS) were evaluated.

Results: Sixteen patients had class I and/or class II PRAs exceeding 50%. Ten patients (9.7%) had DSAs with a mean fluorescence intensity (MFI) higher than 1000, six of whom had antibodies with a high MFI (≥2000). DSAs with high MFIs were more frequently observed in patients with high-grade PGD (≥2) than in those with no or low-grade (≤1) PGD. In the 47 patients who survived for longer than 9 months and were evaluated for BOS after the transplant, BOS was not related to DSA or PRA levels. One-year mortality was more strongly related to PRA class I exceeding 50% than that under 50% (0% vs. 16.7%, p=0.007).

Conclusion: Preoperative DSAs and PRAs are related to worse outcomes after lung transplantation. DSAs and PRAs should be considered when selecting lung transplant recipients, and recipients who have preoperative DSAs with high MFI values and high PRA levels should be monitored closely after lung transplantation.

키워드

Transplantation immunology; lung transplantation; primary graft dysfunction; bronchiolitis obliterans; mortality
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