De Novo Donor Specific Antibody Expression in Lung Transplant Recipients with EVLP-Conditioned Allografts

PurposeRecipients of marginal donor lungs conditioned by ex-vivo lung perfusion (EVLP) have non-inferior short and long-term outcomes compared to recipients of non-EVLP lungs. Whether EVLP increases the risk of de novo donor specific anti-HLA antibodies (dnDSA) early post-transplant has not been reported.MethodsWe performed a single-center, retrospective analysis between 10/2019- 7/2021. EVLP was performed at a specialized center (Lung Bioengineering). Post-lung transplant (LTx) management was similar in both groups. DSA was measured at 1-month post-LTx using a Luminex single-antigen assay. Differences in baseline variables between groups were analyzed using Fisher's exact, Wilcoxon rank-sum or Kruskal-Wallis tests. Multiple logistic regression analysis was then performed to assess the relationship between EVLP and dnDSA, including covariates that were significant on univariate assessment at p<0.2.ResultsDSA were measured in 76 consecutive LTx recipients (LTRs) in the study period; 12 received EVLP-conditioned lungs and 64 did not. Baseline demographics were similar between cohorts except for total ischemic times (Fig 1). At 1-month post-LTx 3 patients (25%) in the EVLP cohort developed class II DSA (all DQ). In the non-EVLP cohort 6 patients (9%) developed class I DSA antibodies (all B) and 11 patients (17%) developed class II DSA (8 with DQ and 3 with DR). When adjusting for gram negative infection and transfused red blood cells, there was no difference in dnDNA incidence between cohorts (Fig 2).ConclusionThe use of EVLP-conditioned donor lungs is not associated with increased incidence of dnDSA early post-LTx. Recipients of marginal donor lungs conditioned by ex-vivo lung perfusion (EVLP) have non-inferior short and long-term outcomes compared to recipients of non-EVLP lungs. Whether EVLP increases the risk of de novo donor specific anti-HLA antibodies (dnDSA) early post-transplant has not been reported. We performed a single-center, retrospective analysis between 10/2019- 7/2021. EVLP was performed at a specialized center (Lung Bioengineering). Post-lung transplant (LTx) management was similar in both groups. DSA was measured at 1-month post-LTx using a Luminex single-antigen assay. Differences in baseline variables between groups were analyzed using Fisher's exact, Wilcoxon rank-sum or Kruskal-Wallis tests. Multiple logistic regression analysis was then performed to assess the relationship between EVLP and dnDSA, including covariates that were significant on univariate assessment at p<0.2. DSA were measured in 76 consecutive LTx recipients (LTRs) in the study period; 12 received EVLP-conditioned lungs and 64 did not. Baseline demographics were similar between cohorts except for total ischemic times (Fig 1). At 1-month post-LTx 3 patients (25%) in the EVLP cohort developed class II DSA (all DQ). In the non-EVLP cohort 6 patients (9%) developed class I DSA antibodies (all B) and 11 patients (17%) developed class II DSA (8 with DQ and 3 with DR). When adjusting for gram negative infection and transfused red blood cells, there was no difference in dnDNA incidence between cohorts (Fig 2). The use of EVLP-conditioned donor lungs is not associated with increased incidence of dnDSA early post-LTx.