Risk Factors for the Development of Antibody-mediated Rejection (AMR) after Lung Transplantation

Purpose Antibody-mediated rejection (AMR) is associated with significant morbidity and mortality after lung transplantation. We sought to identify risk factors for the development of AMR after lung transplantation. Methods We performed a single center retrospective cohort study of 692 patients who underwent lung transplantation (LT) between 2005-2016. We identified those who developed definite AMR (allograft dysfunction, DSA, acute lung injury pathology, C4d deposition, and exclusion of other causes) and performed univariate and multivariate Cox regression analyses to identify potential risk factors for AMR. Results There were significantly more patients with cystic fibrosis (CF) who developed definite AMR (33.8%) than other underlying diagnoses (p = 0.003). Post-transplant gram negative pulmonary infection, analyzed as a time dependent variable, was a significant risk factor for subsequent AMR (HR = 2.263, p = 0.001). In addition, Pseudomonas infection was associated with a significantly higher risk than other gram negative organisms (HR 2.549, p < 0.05). This risk was persistent in multivariable analysis. Furthermore, the diagnosis of CF and cellular rejection (A2) and LB were associated with an increased risk of AMR. Conclusion Patients with CF are at an increased risk of developing AMR. This risk appears to be related to Pseudomonas pulmonary infection. Acute cellular rejection and LB were also found to be an independent risk factor for the development of AMR. Antibody-mediated rejection (AMR) is associated with significant morbidity and mortality after lung transplantation. We sought to identify risk factors for the development of AMR after lung transplantation. We performed a single center retrospective cohort study of 692 patients who underwent lung transplantation (LT) between 2005-2016. We identified those who developed definite AMR (allograft dysfunction, DSA, acute lung injury pathology, C4d deposition, and exclusion of other causes) and performed univariate and multivariate Cox regression analyses to identify potential risk factors for AMR. There were significantly more patients with cystic fibrosis (CF) who developed definite AMR (33.8%) than other underlying diagnoses (p = 0.003). Post-transplant gram negative pulmonary infection, analyzed as a time dependent variable, was a significant risk factor for subsequent AMR (HR = 2.263, p = 0.001). In addition, Pseudomonas infection was associated with a significantly higher risk than other gram negative organisms (HR 2.549, p < 0.05). This risk was persistent in multivariable analysis. Furthermore, the diagnosis of CF and cellular rejection (A2) and LB were associated with an increased risk of AMR. Patients with CF are at an increased risk of developing AMR. This risk appears to be related to Pseudomonas pulmonary infection. Acute cellular rejection and LB were also found to be an independent risk factor for the development of AMR.