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Article ; Online: Impact of perioperative blood transfusions on postoperative renal function and survival after resection of colorectal liver metastases.

Rodieck, Wiebke / Hallensleben, Michael / Robert, Julia / Beetz, Oliver / Grannas, Gerrit / Cammann, Sebastian / Oldhafer, Felix / Klempnauer, Juergen / Vondran, Florian W R / Kulik, Ulf

World journal of surgical oncology

2022 Volume 20, Issue 1, Page(s) 100

Abstract: Background and aims: Recent studies focusing on thoracic surgery suggest postoperative kidney injury depending on the amount of perioperative blood transfusions. Data investigating similar effects after resection of colorectal liver metastases (CRLM) ... ...

Abstract	Background and aims: Recent studies focusing on thoracic surgery suggest postoperative kidney injury depending on the amount of perioperative blood transfusions. Data investigating similar effects after resection of colorectal liver metastases (CRLM) are not available. Aim of this study was therefore to evaluate the influence of perioperative blood transfusions on postoperative renal function and survival after resection of CRLM. Methods: Seven hundred twenty-seven cases of liver resection for CRLM were retrospectively analyzed. Renal function was measured via estimated glomerular filtration rate (eGFR) and a postoperative decline of ≥ 10% was considered substantial. Potential influences on postoperative kidney function were assessed using univariable and multivariable logistic regression analyses. Cox-regression analyses were performed to estimate the impact on overall survival (OS). Results: Preoperative impaired kidney function (p = 0.001, OR 2.477) and transfusion of > 2 units of packed red blood cells (PRBC) (p = 0.046; OR 1.638) were independently associated with an increased risk for ≥ 10% loss of renal function. Neither a pre-existing renal impairment, nor the additional loss of renal function were associated with reduced survival. Chemotherapies in the context of primary colorectal cancer treatment (p = 0.002), age > 70 years at liver resection (p = 0.005), number (p = 0.001), and size of metastases > 50 mm (p = 0.018), duration of resection > 120 min (p = 0.006) and transfusions of > 2 units of PRBC (p = 0.039) showed a negative independent influence on OS. Conclusion: The results demonstrate a negative impact of perioperative blood transfusions on the postoperative renal function and OS. Hence, efforts to reduce blood transfusions should be intensified.
MeSH term(s)	Aged ; Blood Transfusion ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/surgery ; Humans ; Kidney/pathology ; Kidney/physiology ; Liver Neoplasms/secondary ; Retrospective Studies
Language	English
Publishing date	2022-03-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2118383-1
ISSN	1477-7819 ; 1477-7819
ISSN (online)	1477-7819
ISSN	1477-7819
DOI	10.1186/s12957-022-02559-5
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Article ; Online: Lung transplantation despite preformed donor-specific antihuman leukocyte antigen antibodies: a 9-year single-center experience.

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2023 Volume 23, Issue 11, Page(s) 1740–1756

Abstract: Pretransplant allosensitization to human leukocyte antigens (HLA) increases the recipient's waiting list time and mortality in lung transplantation. Rather than waiting for crossmatch-negative donors, since 2013, recipients with preformed donor-specific ... ...

Abstract	Pretransplant allosensitization to human leukocyte antigens (HLA) increases the recipient's waiting list time and mortality in lung transplantation. Rather than waiting for crossmatch-negative donors, since 2013, recipients with preformed donor-specific antiHLA antibodies (pfDSA) have been managed with repeated IgA- and IgM-enriched intravenous immunoglobulin (IgGAM) infusions, usually in combination with plasmapheresis before IgGAM and a single dose of antiCD20 antibody. This retrospective study presents our 9-year experience with patients transplanted with pfDSA. Records of patients transplanted between February 2013 and May 2022 were reviewed. Outcomes were compared between patients with pfDSA and those without any de novo donor-specific antiHLA antibodies. The median follow-up time was 50 months. Of the 1,043 patients who had undergone lung transplantation, 758 (72.7%) did not develop any early donor-specific antiHLA antibodies, and 62 (5.9%) patients exhibited pfDSA. Among the 52 (84%) patients who completed treatment, pfDSA was cleared in 38 (73%). In pfDSA vs control patients and at 8-year follow-up, respectively, graft survival (%) was 75 vs 65 (P = .493) and freedom from chronic lung allograft dysfunction (%) was 63 vs 65 (P = .525). In lung transplantation, crossing the preformed HLA-antibody barrier is safe using a treatment protocol based on IgGAM. Patients with pfDSA have a good 8-year graft survival rate and freedom from chronic lung allograft dysfunction, similar to control patients.
MeSH term(s)	Humans ; Retrospective Studies ; Antibodies ; Tissue Donors ; Lung Transplantation ; HLA Antigens ; Graft Rejection/etiology ; Graft Survival ; Histocompatibility Testing
Chemical Substances	Antibodies ; HLA Antigens
Language	English
Publishing date	2023-05-22
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1016/j.ajt.2023.04.034
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Article ; Online: Heart transplantation across preformed donor-specific antibody barriers using a perioperative desensitization protocol.

Sommer, Wiebke / Avsar, Murat / Aburahma, Khalil / Salman, Jawad / Kaufeld, Klaus Tim / Rojas, Sebastian V / Meyer, Anna L / Chichelnitskiy, Evgeny / Süsal, Caner / Kreusser, Michael M / Verboom, Murielle / Hallensleben, Michael / Bara, Christoph / Blasczyk, Rainer / Falk, Christine / Karck, Matthias / Haverich, Axel / Ius, Fabio / Warnecke, Gregor

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2022 Volume 22, Issue 8, Page(s) 2064–2076

Abstract: Heart transplantation across preformed donor-specific HLA-antibody barriers is associated with impaired short- and long-term survival. Therefore, in recipients with preformed anti-HLA antibodies, waiting for crossmatch-negative donors is standard ... ...

Abstract	Heart transplantation across preformed donor-specific HLA-antibody barriers is associated with impaired short- and long-term survival. Therefore, in recipients with preformed anti-HLA antibodies, waiting for crossmatch-negative donors is standard practice. As an alternative strategy, recipients with preformed anti-HLA donor specific antibodies have been managed at our institutions with a perioperative desensitization regimen. A retrospective analysis was performed comparing heart transplant recipients with preformed donor-specific HLA-antibodies to recipients without donor-specific antibodies. Recipients with a positive virtual crossmatch received a perioperative desensitization protocol including tocilizumab intraoperatively, plasma exchange and rituximab followed by a six-month course of IgGAM. Among the 117 heart-transplanted patients, 19 (16%) patients underwent perioperative desensitization, and the remaining 98 (84%) patients did not. Cold ischemic time, posttransplant extracorporeal life support for primary graft dysfunction, and intensive care unit stay time did not differ between groups. At 1-year follow-up, freedom from pulsed steroid therapy for presumed rejection and biopsy-confirmed acute cellular or humoral rejection did not differ between groups. One-year survival amounted to 94.7% in the treated patients and 81.4% in the control group. Therefore, heart transplantation in sensitized recipients undergoing a perioperative desensitization appears safe with comparable postoperative outcomes as patients with a negative crossmatch.
MeSH term(s)	Antibodies ; Antilymphocyte Serum ; Desensitization, Immunologic/methods ; Graft Rejection/etiology ; Graft Rejection/prevention & control ; Graft Survival ; HLA Antigens ; Heart Transplantation ; Histocompatibility Testing/methods ; Humans ; Kidney Transplantation/adverse effects ; Retrospective Studies
Chemical Substances	Antibodies ; Antilymphocyte Serum ; HLA Antigens
Language	English
Publishing date	2022-04-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1111/ajt.17060
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Article ; Online: Increased frequency of CD4

Transplant international : official journal of the European Society for Organ Transplantation

2020 Volume 33, Issue 5, Page(s) 503–516

Abstract: In this retrospective study, we analyzed the presence of any association of three ... ...

Abstract	In this retrospective study, we analyzed the presence of any association of three CD4
MeSH term(s)	Flow Cytometry ; Graft Survival ; Humans ; Interleukin-2 Receptor alpha Subunit ; Lung Transplantation ; Retrospective Studies ; T-Lymphocytes, Regulatory
Chemical Substances	Interleukin-2 Receptor alpha Subunit
Language	English
Publishing date	2020-01-31
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639435-8
ISSN	1432-2277 ; 0934-0874
ISSN (online)	1432-2277
ISSN	0934-0874
DOI	10.1111/tri.13568
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Zs.A 2358: Show issues

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Article ; Online: Six-year experience with treatment of early donor-specific anti-HLA antibodies in pediatric lung transplantation using a human immunoglobulin-based protocol.

Pediatric pulmonology

2020 Volume 55, Issue 3, Page(s) 754–764

Abstract: Objectives: Experience with the treatment of early donor-specific anti-HLA antibodies (eDSA) after lung transplantation in children is very limited. At our institution, we have treated patients with eDSA since 2013 with successive infusions of ... ...

Abstract	Objectives: Experience with the treatment of early donor-specific anti-HLA antibodies (eDSA) after lung transplantation in children is very limited. At our institution, we have treated patients with eDSA since 2013 with successive infusions of intravenous human immunoglobulins (IVIG), combined in some cases with a single dose of Rituximab and plasmapheresis (therapeutic plasma exchange [tPE]) or immunoabsorption. The aim of this study was to present the 6-year results of IVIG-based therapy in pediatric lung recipients. Methods: Records of pediatric (<18 years old) patients transplanted at our institution between 01/2013 and 03/2019 were reviewed. Outcomes were compared between patients with eDSA treated with IVIG (IVIG group) and without eDSA (control group). Median (interquartile range [IQR]) follow-up amounted to 28 (12-52) months. Results: During the study period, 66 lung-transplanted pediatric patients were included, of which 27 (41%) formed the IVIG group and 38 (57%) the control group. Among the IVIG patients, 14 (52%) patients showed concomitant graft dysfunction (possible clinical antibody-mediated rejection). The median time to eDSA detection was 24 (14-63) days after transplantation. eDSA were cleared in 25 (96%) of the 26 patients which completed treatment. At 3 years, graft survival (%) was 73 vs 85 (P = .65); freedom (%) from chronic lung allograft rejection (CLAD) was 89 vs 78 (P = .82); and from infection 47 vs 31 (P = .15), in IVIG vs control patients, respectively. Conclusions: After lung transplantation, an IVIG-based treatment for eDSA yielded high eDSA clearance. IVIG and control patients showed similar CLAD-free and graft survival.
MeSH term(s)	Adolescent ; Antibodies/therapeutic use ; Child ; Female ; Graft Rejection/prevention & control ; Graft Survival ; HLA Antigens/immunology ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Lung Transplantation ; Male ; Tissue Donors
Chemical Substances	Antibodies ; HLA Antigens ; Immunoglobulins, Intravenous
Language	English
Publishing date	2020-01-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	632784-9
ISSN	1099-0496 ; 8755-6863
ISSN (online)	1099-0496
ISSN	8755-6863
DOI	10.1002/ppul.24639
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Zs.A 2143: Show issues

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Article ; Online: Repeated human leukocyte antigen mismatches in lung re-transplantation.

Sommer, Wiebke / Hallensleben, Michael / Ius, Fabio / Kühn, Christian / Tudorache, Igor / Avsar, Murat / Salman, Jawad / Siemeni, Thierry / Greer, Mark / Gottlieb, Jens / Boethig, Dietmar / Blasczyk, Rainer / Haverich, Axel / Warnecke, Gregor

Transplant immunology

2017 Volume 40, Page(s) 1–7

Abstract: Background: The role of HLA-sensitization in the absence of detectable DSA in lung re-transplantation is unclear. Antigens of the second donor matching the HLA typing of the first donor are considered 'unacceptable', by some tissue typing laboratories, ... ...

Abstract	Background: The role of HLA-sensitization in the absence of detectable DSA in lung re-transplantation is unclear. Antigens of the second donor matching the HLA typing of the first donor are considered 'unacceptable', by some tissue typing laboratories, especially in kidney re-transplantation. Methods: Thus, we performed a retrospective analysis of all lung re-transplantations focussing on the impact of HLA-homologies between the first and the second donor ('unacceptable' antigens; repeated HLA mismatch) on patient and graft survival. Results: A total of 132 lung re-transplantations were performed at our centre between 1985 and 2014, of which 120 with complete HLA data were analysed. 55.8% of the recipients received re-transplants with repeated HLA mismatched antigens whereas 43.2% of the re-transplants were transplanted without repeated HLA mismatched antigens. Postoperative survival showed no difference between re-transplant procedures with or without repeated HLA mismatches (p=0.99). While neither homologies on the HLA-A, -B, -C, or -DR locus, nor the addition of several locus homologies (p=0.72) had an impact on survival, unexpectedly, repeated HLA mismatching on the HLA-DQ locus was correlated with better survival. Re-transplantations with repeated HLA mismatches did not result in more development of CLAD as compared to recipients without repeated HLA mismatches (p=0.99). Neither the number of repeated HLA mismatched antigens (p=0.52) nor the HLA locus (HLA-A(p=0.34), HLA-B(p=0.97), HLA-C (p=0.80), HLA-DR(p=0.49) and HLA-DQ(p=0.07)) had an impact on the development of CLAD after re-transplantation. Conclusion: Transplantation with repeated HLA mismatches due to sensitization by a previous transplantation in the absence of detectable HLA-antibodies does not have a negative impact on patient or graft survival.
Language	English
Publishing date	2017-02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1160846-8
ISSN	1878-5492 ; 0966-3274
ISSN (online)	1878-5492
ISSN	0966-3274
DOI	10.1016/j.trim.2016.12.001
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Zs.A 3784: Show issues

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Article ; Online: Preemptive treatment of early donor-specific antibodies with IgA- and IgM-enriched intravenous human immunoglobulins in lung transplantation.

Ius, Fabio / Verboom, Murielle / Sommer, Wiebke / Poyanmehr, Reza / Knoefel, Ann-Kathrin / Salman, Jawad / Kuehn, Christian / Avsar, Murat / Siemeni, Thierry / Erdfelder, Caroline / Hallensleben, Michael / Boethig, Dietmar / Schwerk, Nicolaus / Mueller, Carsten / Welte, Tobias / Falk, Christine / Haverich, Axel / Tudorache, Igor / Warnecke, Gregor

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

2018 Volume 18, Issue 9, Page(s) 2295–2304

Abstract: This retrospective study presents our 4-year experience of preemptive treatment of early anti-HLA donor specific antibodies with IgA- and IgM-enriched immunoglobulins. We compared outcomes between patients with antibodies and treatment (case patients) ... ...

Abstract	This retrospective study presents our 4-year experience of preemptive treatment of early anti-HLA donor specific antibodies with IgA- and IgM-enriched immunoglobulins. We compared outcomes between patients with antibodies and treatment (case patients) and patients without antibodies (control patients). Records of patients transplanted at our institution between March 2013 and November 2017 were reviewed. The treatment protocol included one single 2 g/kg immunoglobulin infusion followed by successive 0.5 g/kg infusions for a maximum of 6 months, usually combined with a single dose of anti-CD20 antibody and, in case of clinical rejection or positive crossmatch, with plasmapheresis or immunoabsorption. Among the 598 transplanted patients, 128 (21%) patients formed the case group and 452 (76%) the control group. In 116 (91%) patients who completed treatment, 106 (91%) showed no antibodies at treatment end. Fourteen (13%) patients showed antibody recurrence thereafter. In case versus control patients and at 4-year follow-up, respectively, graft survival (%) was 79 versus 81 (P = .59), freedom (%) from biopsy-confirmed rejection 57 versus 53 (P = .34), and from chronic lung allograft dysfunction 82 versus 78 (P = .83). After lung transplantation, patients with early donor-specific antibodies and treated with IgA- and IgM-enriched immunoglobulins had 4-year graft survival similar to patients without antibodies and showed high antibody clearance.
MeSH term(s)	Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Graft Rejection/immunology ; Graft Rejection/prevention & control ; Graft Survival/immunology ; HLA Antigens/immunology ; Histocompatibility Testing ; Humans ; Immunoglobulin A/immunology ; Immunoglobulin M/immunology ; Immunoglobulins, Intravenous/administration & dosage ; Immunoglobulins, Intravenous/immunology ; Isoantibodies/immunology ; Lung Transplantation/methods ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Young Adult
Chemical Substances	HLA Antigens ; Immunoglobulin A ; Immunoglobulin M ; Immunoglobulins, Intravenous ; Isoantibodies
Language	English
Publishing date	2018-06-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2060594-8
ISSN	1600-6143 ; 1600-6135
ISSN (online)	1600-6143
ISSN	1600-6135
DOI	10.1111/ajt.14912
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Article ; Online: IgM-Enriched Human Intravenous Immunoglobulin-Based Treatment of Patients With Early Donor Specific Anti-HLA Antibodies After Lung Transplantation.

Transplantation

2016 Volume 100, Issue 12, Page(s) 2682–2692

Abstract: Background: At our institution, until April 2013, patients who showed early donor specific anti-HLA antibodies (DSA) after lung transplantation were preemptively treated with therapeutic plasma exchange (tPE) and a single dose of Rituximab. In April ... ...

Abstract	Background: At our institution, until April 2013, patients who showed early donor specific anti-HLA antibodies (DSA) after lung transplantation were preemptively treated with therapeutic plasma exchange (tPE) and a single dose of Rituximab. In April 2013, we moved to a therapy based on IgM-enriched human immunoglobulins (IVIG), repeated every 4 weeks, and a single dose of Rituximab. Methods: This observational study was designed to evaluate the short-term patient and graft survival in patients who underwent IVIG-based DSA treatment (group A, n = 57) versus contemporary patients transplanted between April 2013 and January 2015 without DSA (group C, n = 180), as well as to evaluate DSA clearance in IVIG-treated patients versus historic patients who had undergone tPE-based treatment (group B, n = 56). Patient records were retrospectively reviewed. Follow-up ended on April 1, 2015. Results: At 6 months and 1 year of follow-up, group A had a survival similar to group C (P = 0.81) but better than group B (P = 0.008). Group A showed statistically nonsignificant trends toward improved freedom from pulsed-steroid therapy and biopsy-confirmed rejection over groups B and C. The DSA clearance was better in group A than group B at treatment end (92% vs 64%; P = 0.002) and last DSA control (90% vs 75%; P = 0.04). Conclusions: Patients with new early DSA but without graft dysfunction that are treated with IVIG and Rituximab have similarly good early survival as contemporary lung transplant recipients without early DSA. The IVIG yielded increased DSA clearance compared with historic tPE-based treatment, yet spontaneous clearance of new DSA also remains common.
MeSH term(s)	Adult ; Female ; Graft Survival ; HLA Antigens/immunology ; Humans ; Immunoglobulin M/therapeutic use ; Immunoglobulins, Intravenous/therapeutic use ; Lung Transplantation ; Male ; Middle Aged ; Plasma Exchange ; Retrospective Studies ; Rituximab/administration & dosage ; Time Factors ; Tissue Donors ; Treatment Outcome
Chemical Substances	HLA Antigens ; Immunoglobulin M ; Immunoglobulins, Intravenous ; Rituximab (4F4X42SYQ6)
Language	English
Publishing date	2016-12
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000001027
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Zs.A 488: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Early donor-specific antibodies in lung transplantation: risk factors and impact on survival.

Ius, Fabio / Sommer, Wiebke / Tudorache, Igor / Kühn, Christian / Avsar, Murat / Siemeni, Thierry / Salman, Jawad / Hallensleben, Michael / Kieneke, Daniela / Greer, Mark / Gottlieb, Jens / Haverich, Axel / Warnecke, Gregor

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

2014 Volume 33, Issue 12, Page(s) 1255–1263

Abstract: Background: The impact of early donor-specific anti-HLA antibodies (DSA) on patient and graft survival after lung transplantation remains controversial. In this study we analyzed risk factors for DSA that developed before initial hospital discharge ... ...

Abstract	Background: The impact of early donor-specific anti-HLA antibodies (DSA) on patient and graft survival after lung transplantation remains controversial. In this study we analyzed risk factors for DSA that developed before initial hospital discharge after lung transplantation (early DSA) and compared mid-term outcomes in patients with or without DSA. Methods: Between January 2009 and August 2013, 546 patients underwent lung transplantation at our institution. One hundred (18%) patients developed early DSA (Group A) and 446 (82%) patients (Group B) did not. Patient records were retrospectively reviewed. Results: Retransplantation (odds ratio [OR] = 2.7, 95% confidence interval [CI] 1.1 to 6.5, p = 0.03), pre-operative HLA antibodies (OR = 2.1, 95% CI 1.2 to 3.4, p = 0.003) and primary graft dysfunction (PGD) score Grade 2 or 3 at 48 hours (OR = 2.6, 95% CI 1.5 to 4.6, p = 0.001) were associated with early DSA development. Overall, 1- and 3-year survival in Group A and B patients was 79 ± 4% vs 88 ± 2% and 57 ± 8% vs 74 ± 3%, respectively (p = 0.019). Eleven Group A (11%) and 32 Group B (7%) patients died before hospital discharge (p = 0.34). Among patients surviving beyond discharge, 1- and 3-year survival in Group A and B patients was 89 ± 4% vs 95 ± 1% and 65 ± 8% vs 80 ± 3% in Group A and B patients, respectively (p = 0.04). Multivariate analysis identified early anti-HLA Class II DSA (OR = 1.9, 95% CI 1.0 to 3.4, p = 0.04) as an independent risk factor for post-discharge mortality but not for in-hospital mortality. Conclusions: Pre-operative HLA antibodies, retransplantation or post-operative PGD increase the risk of developing early DSA, which were independently associated with an increased risk for mortality.
MeSH term(s)	Adult ; Antibodies, Anti-Idiotypic/immunology ; Female ; Graft Rejection/epidemiology ; Graft Rejection/immunology ; Graft Rejection/mortality ; HLA Antigens/immunology ; Humans ; Lung/immunology ; Lung Transplantation/mortality ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Survival Rate ; Tissue Donors ; Treatment Outcome
Chemical Substances	Antibodies, Anti-Idiotypic ; HLA Antigens
Language	English
Publishing date	2014-12
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	1062522-7
ISSN	1557-3117 ; 1053-2498
ISSN (online)	1557-3117
ISSN	1053-2498
DOI	10.1016/j.healun.2014.06.015
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Zs.A 2056: Show issues

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Article ; Online: Preemptive treatment with therapeutic plasma exchange and rituximab for early donor-specific antibodies after lung transplantation.

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

2014 Volume 34, Issue 1, Page(s) 50–58

Abstract: Objective: De novo donor-specific anti-human leukocyte antigen antibodies develop in a high proportion of lung transplant recipients early after lung transplantation. We recently showed that de novo donor-specific antibodies (DSA) occurrence is ... ...

Abstract	Objective: De novo donor-specific anti-human leukocyte antigen antibodies develop in a high proportion of lung transplant recipients early after lung transplantation. We recently showed that de novo donor-specific antibodies (DSA) occurrence is associated with significantly increased mortality. Here, we studied the efficacy of a preemptive treatment protocol. Methods: A retrospective observational study was conducted on all lung transplantations at Hanover Medical School between January 2009 and May 2013. Results: Among the 500 transplant recipients, early DSA developed in 86 (17%). Of these, 56 patients (65%; Group A) received therapeutic plasma exchange, and 30 patients (35%; Group B) did not. Among Group A patients, 51 also received rituximab. Between groups, there was no statistically significant difference in mortality, incidence of pulsed steroid therapies, rejections diagnosed by biopsy specimen, incidence of bronchitis obliterans syndrome (BOS), or infections requiring hospitalization at 1 year and 3 years. Also, there were no statistically significant differences after matching 21 Group A with 21 Group B patients through propensity score analysis. Significantly more Group A patients (65%) than Group B patients (34%) cleared DSA at hospital discharge (p = 0.01). At the last control after transplantation (median, 14 months; interquartile range, 5-24 months), 11 Group A (22%) and 9 Group B patients (33%) still showed DSA (p = 0.28). Conclusions: Preemptive treatment with therapeutic plasma exchange and rituximab led to improved elimination of DSA early after lung transplantation (p = 0.01). However, spontaneous elimination in untreated Group B patients also occurred frequently. This treatment protocol was not associated with significantly improved outcome.
MeSH term(s)	Adult ; Antibodies/immunology ; Antibodies, Monoclonal, Murine-Derived/therapeutic use ; Antigens, CD20 ; Female ; Germany/epidemiology ; Graft Rejection/epidemiology ; Graft Rejection/immunology ; Graft Rejection/therapy ; HLA Antigens/immunology ; Humans ; Immunologic Factors/therapeutic use ; Incidence ; Lung Transplantation ; Male ; Middle Aged ; Plasma Exchange/methods ; Retrospective Studies ; Rituximab ; Survival Rate/trends ; Tissue Donors
Chemical Substances	Antibodies ; Antibodies, Monoclonal, Murine-Derived ; Antigens, CD20 ; HLA Antigens ; Immunologic Factors ; Rituximab (4F4X42SYQ6)
Language	English
Publishing date	2014-09-28
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	1062522-7
ISSN	1557-3117 ; 1053-2498
ISSN (online)	1557-3117
ISSN	1053-2498
DOI	10.1016/j.healun.2014.09.019
Database	MEDical Literature Analysis and Retrieval System OnLINE

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