Prevalence of pre-transplant anti-HLA antibodies and their impact on outcomes in lung transplant recipients

BACKGROUND: The antibodies to human leukocyte antigen (HLA) have been suggested to be associated with outcomes in lung transplantation. However, data is limited in Asia. OBJECTIVES: We were to investigate the prevalence of anti-HLA antibodies before transplantation and to assess their impact on outcomes in lung transplant recipients in Korea. METHODS: We conducted a single-center retrospective study including 76 patients who received lung transplant at tertiary hospital in South Korea between January 2010 and March 2015. RESULTS: Nine patients (11.8%) had class I or class II panel-reactive antibody that was elevated above 50%. Thirteen patients (17.1%) had anti-HLA antibodies with low mean fluorescent intensity (MFI, 1000-3000), 7 (9.2%) with moderate MFI (3000-5000), and 12 (15.8%) with high MFI (>5000). Ten (13.2%) had suspected donor-specific antibodies (DSA), and 60% (6/10) had antibodies with high MFI. In the analysis of outcomes, high-grade (grade≥2) primary graft dysfunction was more frequent in patients with anti-HLA antibodies of moderate to high MFI than in patients with low MFI (39.4% vs. 14.0%, p =0.011). Of the 20 patients who survived more than 2 years after transplant, bronchiolitis obliterans syndrome was more frequent in patients with anti-HLA antibodies of moderate to high MFI than in patients with low MFI, although this difference was not statistically significant (50.0% vs. 14.3%, p =0.091). CONCLUSIONS: The prevalence of anti-HLA antibodies with high MFI was not high. However, the MFI was relatively high in patients with DSA. Anti-HLA antibodies with moderate to high MFI could also be associated with outcomes in lung transplant recipients in Korea.