What is a clinically significant donor-specific antibody before lung transplantation?

In 1969, Patel and Terasaki 1 Patel R. Terasaki P.I. Significance of the positive crossmatch test in kidney transplantation. N Engl J Med. 1969; 280: 735-739https://doi.org/10.1056/NEJM196904032801401 Crossref PubMed Scopus (1249) Google Scholar demonstrated the role of crossmatching in solid-organ transplantation. In this landmark study, 24 of 30 kidney transplant recipients who had a positive crossmatch had immediate graft failure, demonstrating that cytotoxic donor-specific antibodies (DSAs) are a strong contraindication to transplantation. 1 Patel R. Terasaki P.I. Significance of the positive crossmatch test in kidney transplantation. N Engl J Med. 1969; 280: 735-739https://doi.org/10.1056/NEJM196904032801401 Crossref PubMed Scopus (1249) Google Scholar Since then, methods to identify human leukocyte antigen (HLA) antibodies and their specificities have improved significantly, and the widespread use of the virtual crossmatch has made hyperacute rejection exceedingly rare. However, sensitive antibody detection assays such as single antigen bead assay identify more allosensitized patients, but it has become increasingly clear that not all HLA antibodies have the same deleterious effect on the allograft. This emphasizes the importance of close collaboration between clinicians and the HLA laboratory in managing allosensitized patients. Outcomes after flow cytometry crossmatch-positive lung transplants managed with perioperative desensitizationAmerican Journal of TransplantationPreviewOur program previously reported successful outcomes following virtual crossmatch (VXM)–positive lung transplants managed with perioperative desensitization, but our ability to stratify their immunologic risk was limited without flow cytometry crossmatch (FCXM) data before 2014. The aim of this study was to determine allograft and chronic lung allograft dysfunction (CLAD)–free survival following VXM-positive/FCXM-positive lung transplants, which are performed at a minority of programs due to the high immunologic risk and lack of data on outcomes. Full-Text PDF Lung transplantation despite preformed donor-specific antihuman leukocyte antigen antibodies: a 9-year single-center experienceAmerican Journal of TransplantationPreviewPretransplant 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. Full-Text PDF