Korean J Transplant.  2022 Nov;36(Supple 1):S135. 10.4285/ATW2022.F-2565.

Preexisting nonhuman leukocyte antigen antibodies are associated with allograft rejection after thoracic transplantation

• Yeo HJ
• Jang JH
• Cho WH
• Kim T

• KMID: 2535651
• DOI: http://doi.org/10.4285/ATW2022.F-2565

Abstract

There is growing evidence of an important role of non-human leukocyte antigen (HLA) antibodies in lung and heart transplant rejection. However, data on the prevalence and clinical significance of non-HLA antibodies in the Asian population are scarce. We used a Luminex machine to measure non-HLA antibodies in patients who underwent heart (n=28) or lung transplantation (n=36) between 2016 and 2019. We evaluated the association between pre-existing non-HLA antibodies and acute rejec-tion-free days in heart and lung transplant recipients. Of the 64 patients, acute allograft rejection occurred in 27 (42.2%). Acute cellular rejection occurred in 26 (40.6%) patients, and acute antibody-mediated rejection occurred in one (1.6%) patient. Among 33 non-HLA antibodies, only the anti-glutathione S-transferase theta-1 (GSTT1) antibody positive rate was significantly higher in the acute rejection group compared to the no rejection group (40.7% vs. 13.5%, P=0.013). The angiotensin II type I receptor (AT1R) positive rate was not significantly different between the two groups (40% vs. 18.5%, P=0.129). In the multivariate Cox re-gression analysis, anti-GSTT1 antibody-positive patients had a higher risk of acute allograft rejection (hazard ratio, 2.33; 95% confidence interval [CI], 1.08–5.04; P=0.032). The Kaplan-Meier curve showed that anti-GSTT1 antibody-positive patients had fewer acute rejection-free days (c 2 =5.50; P=0.019). In addition, patients who underwent packed red cell transfusion (odds ratio [OR], 1.30; 95% CI, 1.07–1.57; P=0.007) or mechanical ventilation (OR, 20.83; 95% CI, 2.49–173.97; P=0.005) before transplanta-tion were more likely to be positive for anti-GSTT1 antibody. Patients with antibodies against GSTT1 before heart or lung trans-plantation had an increased risk of acute rejection.