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

 Sung Woo Moon  ;  Moo Suk Park  ;  Jin Gu Lee  ;  Hyo Chae Paik  ;  Young Tae Kim  ;  Hyun Joo Lee  ;  Samina Park  ;  Sun Mi Choi  ;  Do Hyung Kim  ;  Woo Hyun Cho  ;  Hye Ju Yeo  ;  Seung Il Park  ;  Se Hoon Choi  ;  Sang Bum Hong  ;  Tae Sun Shim  ;  Kyung Wook Jo  ;  Kyeongman Jeon  ;  Byeong Ho Jeong  ;  Song Yee Kim  ;  Korean Organ Transplantation Registry Study Group 
 YONSEI MEDICAL JOURNAL, Vol.61(7) : 606-613, 2020-07 
Journal Title
Issue Date
Adult ; Aged ; Antibodies / immunology* ; Bronchiolitis Obliterans / diagnosis ; Bronchiolitis Obliterans / etiology* ; Bronchiolitis Obliterans / mortality ; Female ; Humans ; Lung ; Lung Transplantation / adverse effects* ; Male ; Middle Aged ; Prevalence ; Primary Graft Dysfunction / immunology* ; Republic of Korea / epidemiology ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Tissue Donors*
Transplantation immunology ; bronchiolitis obliterans ; lung transplantation ; mortality ; primary graft dysfunction
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Song Yee(김송이) ORCID logo https://orcid.org/0000-0001-8627-486X
Moon, Sung Woo(문성우) ORCID logo https://orcid.org/0000-0001-9917-9802
Park, Moo Suk(박무석) ORCID logo https://orcid.org/0000-0003-0820-7615
Paik, Hyo Chae(백효채) ORCID logo https://orcid.org/0000-0001-9309-8235
Lee, Jin Gu(이진구)
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