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Pseudomonas aeruginosa and acute rejection independently increase the risk of donor-specific antibodies after lung transplantation.

Authors
  • Kulkarni, Hrishikesh S1
  • Tsui, Kevin2
  • Sunder, Suraj1
  • Ganninger, Alex1
  • Tague, Laneshia K1
  • Witt, Chad A1
  • Byers, Derek E1
  • Trulock, Elbert P1
  • Nava, Ruben3
  • Puri, Varun3
  • Kreisel, Daniel3
  • Mohanakumar, Thalachallour4
  • Gelman, Andrew E3, 5
  • Hachem, Ramsey R1
  • 1 Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA.
  • 2 Advocate Christ Medical Center, Chicago, Illinois, USA.
  • 3 Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA.
  • 4 Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
  • 5 Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA.
Type
Published Article
Journal
American Journal of Transplantation
Publisher
Wiley (Blackwell Publishing)
Publication Date
Apr 01, 2020
Volume
20
Issue
4
Pages
1028–1038
Identifiers
DOI: 10.1111/ajt.15687
PMID: 31677358
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Factors contributing to donor-specific HLA antibody (DSA) development after lung transplantation have not been systematically evaluated. We hypothesized that the isolation of Pseudomonas aeruginosa in respiratory specimens would increase the risk of DSA development. Our objective was to determine the risk of DSA development associated with the isolation of Pseudomonas aeruginosa after lung transplantation. We conducted a single-center retrospective cohort study of primary lung transplant recipients and examined risk factors for DSA development using Cox regression models. Of 460 recipients, 205 (45%) developed DSA; the majority developed Class II DSA (n = 175, 85%), and 145 of 205 (71%) developed DSA to HLA-DQ alleles. Univariate time-dependent analyses revealed that isolation of Pseudomonas from respiratory specimens, acute cellular rejection, and lymphocytic bronchiolitis are associated with an increased risk of DSA development. In multivariable analyses, Pseudomonas isolation, acute cellular rejection, and lymphocytic bronchiolitis remained independent risk factors for DSA development. Additionally, there was a direct association between the number of positive Pseudomonas cultures and the risk of DSA development. Our findings suggest that pro-inflammatory events including acute cellular rejection, lymphocytic bronchiolitis, and Pseudomonas isolation after transplantation are associated with an increased risk of DSA development. © 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.

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