Induction immunosuppression strategies and outcomes post-lung transplant: A single center experience.

Publisher: Elsevier Country of Publication: Netherlands NLM ID: 9309923 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-5492 (Electronic) Linking ISSN: 09663274 NLM ISO Abbreviation: Transpl Immunol Subsets: MEDLINE

Publication: Amsterdam : Elsevier
Original Publication: Dunton Green, Sevenoaks, Kent, UK : Edward Arnold, c1993-

Lung Transplantation* ; Graft Rejection*/immunology ; Graft Rejection*/prevention & control ; Antilymphocyte Serum*/therapeutic use ; Alemtuzumab*/therapeutic use ; Immunosuppression Therapy*/methods; Humans ; Male ; Middle Aged ; Female ; Adult ; Immunosuppressive Agents/therapeutic use ; Animals ; Aged ; Retrospective Studies ; Graft Survival ; Rabbits ; Treatment Outcome ; HLA Antigens/immunology ; Isoantibodies/blood

Purpose: Currently 80% of lung transplant centers use induction immunosuppression. However, there is a lack of standardization of induction protocols within and across lung transplant centers. This study explores the association of two different induction immunosuppression strategies used at our center [single dose rabbit antithymocyte globulin (rATG) vs. alemtuzumab] compared to no induction with immunologic and clinical outcomes after lung transplantation.
Methods: A total of 174 consecutive lung transplant recipients (LTR) between 2016 and 2019 were included in the analysis. Twenty nine LTR (16.7%) received no induction, 22 LTR (12.6%) received alemtuzumab, 123 LTR (70.6%) received a single dose of rATG; 1.5 mg/kg within 24 h of transplant for induction. All LTR had a negative flow cytometry crossmatch on the day of the transplant. All LTR were assessed for de novo HLA donor-specific antibodies (DSA) development and clinical outcomes, including the risk of acute cellular rejection (ACR), antibody-mediated rejection (AMR), chronic lung allograft dysfunction (CLAD), and overall survival post-transplant.
Results: The median lung allocation score (LAS) was significantly higher in LTR that did not receive Induction immunosuppression (76; range = 35.3-94.3) compared to induction with rATG (41.6; range = 31.6-91) and alemtuzumab (51; range = 33.1-88.2) (p < 0.001). De novo HLA DSA were detected in 50/174 (28.7%) LTR within 12 months post-transplant. They were detected in 13/29 (44.8%) LTR without induction immunosuppression compared to 28/123 (22.8%) and 9/22 (40.9%) LTR with rATG and alemtuzumab induction, respectively (p = 0.02). The percent freedom from ACR rates between LTR who received alemtuzumab induction was significantly higher compared to LTR who received rATG or no induction at 1 (p = 0.02), 2 (p = 0.01) and 3 (p = 0.05) years post-transplant. In addition, the overall 1-year survival rates were significantly higher in LTR who received rATG or alemtuzumab induction compared to LTR without induction immunosuppression (p = 0.02).
Conclusion: Induction immunosuppression strategies utilizing rATG or Alemtuzumab have unique and contrasting benefits in LTR. Combination of alemtuzumab induction and a lower dose of maintenance immunosuppression may reduce the incidence of ACR in LTR. Single-dose rATG or alemtuzumab induction immunosuppression may also improve the 1 year overall LTR survival compared to no induction.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier B.V. All rights reserved.)

Keywords: HLA antibodies; Immune induction; Lung transplant; Outcome; Rejection; Survival

0 (Antilymphocyte Serum)
3A189DH42V (Alemtuzumab)
0 (Immunosuppressive Agents)
0 (HLA Antigens)
0 (Isoantibodies)

Date Created: 20240710 Date Completed: 20240721 Latest Revision: 20240721

20240722

10.1016/j.trim.2024.102081

38986916