Chest
Clinical InvestigationsBronchiolitisHuman Leukocyte Antigen Mismatches Predispose to the Severity of Bronchiolitis Obliterans Syndrome After Lung Transplantationa
Section snippets
Materials and Methods
Lung allograft recipients who received their transplants at our institution were studied. The selection criteria, operative techniques for the donors and recipients, and medical management have been published.1819A cross-sectional analysis of BOS stage was determined at two time points (the 3-year and 4-year transplant anniversaries) using internationally promulgated guidelines23with a minor modification (which allowed transplant recipients who were affected early by BOS and had died before 3
Patients
One hundred eighty-six lung transplants were performed between January 1990 and January 2000. Only 119 transplant recipients had accrued sufficient posttransplant time to reach their 4-year anniversary at the time of this study. Of these patients, 47 had died due to causes other than BOS (ie, graft failure within 90 days posttransplant, 24 patients; infections, 11 patients; sepsis, 4 patients; PTLDs, 3 patients; malignancy, 1 patient; stroke, 1 patient; and others, 3 patients). Eight patients
Discussion
The results in this study demonstrate that the degree of HLA class I loci mismatching independently predicted the severity of BOS at 4 years (or 3 years) after lung transplantation, irrespective of other pretransplant and/or posttransplant variables. We reasoned that the severity of immunologic injury and fibroproliferative response determines the onset, severity, and progression of BOS and took advantage of staging BOS in all patients uniformly at a single institution at a predesignated time
Acknowledgment
The authors thank Steve Wagoner for his continuing support, Cher R. Wilson for her assistance in validating the HLA data, and Drs. Thomas Egan and Frank Detterbeck and the Cardiothoracic Division in the Department of Surgery who performed all of the transplants from which our database is derived. We also thank our lung transplant coordinators, Judy McSweeney, Jean Rea, Kristi Gott, Brandi Mueller, and Ken Davis for their excellent care of the lung transplant candidates and recipients at The
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Chronic Lung Allograft Dysfunction
2021, Encyclopedia of Respiratory Medicine, Second EditionRespiratory viral infection in lung transplantation induces exosomes that trigger chronic rejection
2020, Journal of Heart and Lung TransplantationTransplantation-Related Lung Pathology
2018, Pulmonary Pathology: A Volume in the Series: Foundations in Diagnostic PathologyHuman leukocyte antigen-DR13 and DR15 are associated with short-term lung transplant outcomes
2016, Journal of Surgical ResearchCitation Excerpt :They also found that col(V) positive recipients were more likely to have the HLA-DR1 allele but less likely to have the HLA-DR13 allele than controls.5 In addition, there are numerous other reports of HLA mismatches, including HLA-DR–specific mismatches, being associated with decreased survival and increased incidence of BOS.6-9 However, to our understanding, there is currently no published large-scale study that compares the survival and incidence of BOS with respect to donor and recipient HLA-DR positivity in the aforementioned alleles.
Influence of human leukocyte antigen mismatching on bronchiolitis obliterans syndrome in lung transplantation
2016, Journal of Heart and Lung TransplantationCitation Excerpt :The medical literature regarding HLA mismatching and its influence on BOS after LTx is not vigorous. The majority of the research consists of single-center studies or collaborations among a small number of transplant centers with a wide range of results regarding loci matching and development of BOS after LTx.5–12 A few studies have attempted to further investigate HLA mismatching in larger databases.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).
This research was funded, in parts, by the National and North Carolina Chapters of the American Lung Association and the Cystic Fibrosis Foundation.