Predictors of acute rejection after lung transplantation

Abeel A. Mangi, David P. Mason, Edward R. Nowicki, Lillian H. Batizy, Sudish C. Murthy, Diane J. Pidwell, Robin Avery, Kenneth R. McCurry, Gösta B. Pettersson, Eugene H. Blackstone

Research output: Contribution to journalArticle

Abstract

Background: Acute rejection (AR) after lung transplantation (LTx) impacts survival and quality of life. The objective of this study, therefore, was to identify risk factors for AR after LTx, focusing on donor- and recipient-specific factors, operative variables, and immunologic issues, including pretransplant panel-reactive antibody (PRA) levels, and donor-recipient human leukocyte antigen (HLA) mismatch. Methods: From March 1996 to November 2007, 481 adults undergoing LTx had 3237 serial transbronchial biopsy specimens that were evaluated for perivascular rejection (grade A0 to A4). Longitudinal analysis was used to characterize the prevalence of rejection grade and influence of donor, recipient, technical, and immunologic variables. Results: AR was highest (54% <A1) in the first 2 months after LTx, decreased at 6 months (16% <A1), then remained steady. Prevalence of AR at any time was dominated by donor-specific factors of young age (p <0.0001), blunt trauma (p = 0.008), and nonblack race (p = 0.012) and by recipient class II PRA exceeding 10% (p = 0.005). AR within 2 months was associated with HLA mismatch at the DR locus (p = 0.0006) and use of non-O blood-group donors (p = 0.008). AR at 4 years and longer after LTx was associated with HLA mismatch at the B locus (p = 0.01). Conclusions: Only a few recipient and operative factors were identified for AR after LTx. Moderately sensitized recipients identified by class II PRA exceeding 10% and those with HLA mismatches at the B and DR loci appear to be more susceptible to AR; however, such immunologic variations appear to be well controlled with current donor selection and immunosuppression protocols. The impact of donor-specific variables on AR is surprisingly strong and warrants closer inspection.

Original languageEnglish (US)
Pages (from-to)1754-1762
Number of pages9
JournalAnnals of Thoracic Surgery
Volume91
Issue number6
DOIs
StatePublished - Jun 2011
Externally publishedYes

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Lung Transplantation
HLA Antigens
Tissue Donors
Antibodies
Donor Selection
Age Factors
Blood Group Antigens
Blood Donors
Immunosuppression
Quality of Life
Biopsy
Wounds and Injuries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Mangi, A. A., Mason, D. P., Nowicki, E. R., Batizy, L. H., Murthy, S. C., Pidwell, D. J., ... Blackstone, E. H. (2011). Predictors of acute rejection after lung transplantation. Annals of Thoracic Surgery, 91(6), 1754-1762. https://doi.org/10.1016/j.athoracsur.2011.01.076

Predictors of acute rejection after lung transplantation. / Mangi, Abeel A.; Mason, David P.; Nowicki, Edward R.; Batizy, Lillian H.; Murthy, Sudish C.; Pidwell, Diane J.; Avery, Robin; McCurry, Kenneth R.; Pettersson, Gösta B.; Blackstone, Eugene H.

In: Annals of Thoracic Surgery, Vol. 91, No. 6, 06.2011, p. 1754-1762.

Research output: Contribution to journalArticle

Mangi, AA, Mason, DP, Nowicki, ER, Batizy, LH, Murthy, SC, Pidwell, DJ, Avery, R, McCurry, KR, Pettersson, GB & Blackstone, EH 2011, 'Predictors of acute rejection after lung transplantation', Annals of Thoracic Surgery, vol. 91, no. 6, pp. 1754-1762. https://doi.org/10.1016/j.athoracsur.2011.01.076
Mangi AA, Mason DP, Nowicki ER, Batizy LH, Murthy SC, Pidwell DJ et al. Predictors of acute rejection after lung transplantation. Annals of Thoracic Surgery. 2011 Jun;91(6):1754-1762. https://doi.org/10.1016/j.athoracsur.2011.01.076
Mangi, Abeel A. ; Mason, David P. ; Nowicki, Edward R. ; Batizy, Lillian H. ; Murthy, Sudish C. ; Pidwell, Diane J. ; Avery, Robin ; McCurry, Kenneth R. ; Pettersson, Gösta B. ; Blackstone, Eugene H. / Predictors of acute rejection after lung transplantation. In: Annals of Thoracic Surgery. 2011 ; Vol. 91, No. 6. pp. 1754-1762.
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abstract = "Background: Acute rejection (AR) after lung transplantation (LTx) impacts survival and quality of life. The objective of this study, therefore, was to identify risk factors for AR after LTx, focusing on donor- and recipient-specific factors, operative variables, and immunologic issues, including pretransplant panel-reactive antibody (PRA) levels, and donor-recipient human leukocyte antigen (HLA) mismatch. Methods: From March 1996 to November 2007, 481 adults undergoing LTx had 3237 serial transbronchial biopsy specimens that were evaluated for perivascular rejection (grade A0 to A4). Longitudinal analysis was used to characterize the prevalence of rejection grade and influence of donor, recipient, technical, and immunologic variables. Results: AR was highest (54{\%} <A1) in the first 2 months after LTx, decreased at 6 months (16{\%} <A1), then remained steady. Prevalence of AR at any time was dominated by donor-specific factors of young age (p <0.0001), blunt trauma (p = 0.008), and nonblack race (p = 0.012) and by recipient class II PRA exceeding 10{\%} (p = 0.005). AR within 2 months was associated with HLA mismatch at the DR locus (p = 0.0006) and use of non-O blood-group donors (p = 0.008). AR at 4 years and longer after LTx was associated with HLA mismatch at the B locus (p = 0.01). Conclusions: Only a few recipient and operative factors were identified for AR after LTx. Moderately sensitized recipients identified by class II PRA exceeding 10{\%} and those with HLA mismatches at the B and DR loci appear to be more susceptible to AR; however, such immunologic variations appear to be well controlled with current donor selection and immunosuppression protocols. The impact of donor-specific variables on AR is surprisingly strong and warrants closer inspection.",
author = "Mangi, {Abeel A.} and Mason, {David P.} and Nowicki, {Edward R.} and Batizy, {Lillian H.} and Murthy, {Sudish C.} and Pidwell, {Diane J.} and Robin Avery and McCurry, {Kenneth R.} and Pettersson, {G{\"o}sta B.} and Blackstone, {Eugene H.}",
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T1 - Predictors of acute rejection after lung transplantation

AU - Mangi, Abeel A.

AU - Mason, David P.

AU - Nowicki, Edward R.

AU - Batizy, Lillian H.

AU - Murthy, Sudish C.

AU - Pidwell, Diane J.

AU - Avery, Robin

AU - McCurry, Kenneth R.

AU - Pettersson, Gösta B.

AU - Blackstone, Eugene H.

PY - 2011/6

Y1 - 2011/6

N2 - Background: Acute rejection (AR) after lung transplantation (LTx) impacts survival and quality of life. The objective of this study, therefore, was to identify risk factors for AR after LTx, focusing on donor- and recipient-specific factors, operative variables, and immunologic issues, including pretransplant panel-reactive antibody (PRA) levels, and donor-recipient human leukocyte antigen (HLA) mismatch. Methods: From March 1996 to November 2007, 481 adults undergoing LTx had 3237 serial transbronchial biopsy specimens that were evaluated for perivascular rejection (grade A0 to A4). Longitudinal analysis was used to characterize the prevalence of rejection grade and influence of donor, recipient, technical, and immunologic variables. Results: AR was highest (54% <A1) in the first 2 months after LTx, decreased at 6 months (16% <A1), then remained steady. Prevalence of AR at any time was dominated by donor-specific factors of young age (p <0.0001), blunt trauma (p = 0.008), and nonblack race (p = 0.012) and by recipient class II PRA exceeding 10% (p = 0.005). AR within 2 months was associated with HLA mismatch at the DR locus (p = 0.0006) and use of non-O blood-group donors (p = 0.008). AR at 4 years and longer after LTx was associated with HLA mismatch at the B locus (p = 0.01). Conclusions: Only a few recipient and operative factors were identified for AR after LTx. Moderately sensitized recipients identified by class II PRA exceeding 10% and those with HLA mismatches at the B and DR loci appear to be more susceptible to AR; however, such immunologic variations appear to be well controlled with current donor selection and immunosuppression protocols. The impact of donor-specific variables on AR is surprisingly strong and warrants closer inspection.

AB - Background: Acute rejection (AR) after lung transplantation (LTx) impacts survival and quality of life. The objective of this study, therefore, was to identify risk factors for AR after LTx, focusing on donor- and recipient-specific factors, operative variables, and immunologic issues, including pretransplant panel-reactive antibody (PRA) levels, and donor-recipient human leukocyte antigen (HLA) mismatch. Methods: From March 1996 to November 2007, 481 adults undergoing LTx had 3237 serial transbronchial biopsy specimens that were evaluated for perivascular rejection (grade A0 to A4). Longitudinal analysis was used to characterize the prevalence of rejection grade and influence of donor, recipient, technical, and immunologic variables. Results: AR was highest (54% <A1) in the first 2 months after LTx, decreased at 6 months (16% <A1), then remained steady. Prevalence of AR at any time was dominated by donor-specific factors of young age (p <0.0001), blunt trauma (p = 0.008), and nonblack race (p = 0.012) and by recipient class II PRA exceeding 10% (p = 0.005). AR within 2 months was associated with HLA mismatch at the DR locus (p = 0.0006) and use of non-O blood-group donors (p = 0.008). AR at 4 years and longer after LTx was associated with HLA mismatch at the B locus (p = 0.01). Conclusions: Only a few recipient and operative factors were identified for AR after LTx. Moderately sensitized recipients identified by class II PRA exceeding 10% and those with HLA mismatches at the B and DR loci appear to be more susceptible to AR; however, such immunologic variations appear to be well controlled with current donor selection and immunosuppression protocols. The impact of donor-specific variables on AR is surprisingly strong and warrants closer inspection.

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