PMID- 21536252
OWN - NLM
STAT- MEDLINE
DCOM- 20110811
LR  - 20220321
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 91
IP  - 6
DP  - 2011 Jun
TI  - Predictors of acute rejection after lung transplantation.
PG  - 1754-62
LID - 10.1016/j.athoracsur.2011.01.076 [doi]
AB  - BACKGROUND: Acute rejection (AR) after lung transplantation (LTx) impacts 
      survival and quality of life. The objective of this study, therefore, was to 
      identify risk factors for AR after LTx, focusing on donor- and recipient-specific 
      factors, operative variables, and immunologic issues, including pretransplant 
      panel-reactive antibody (PRA) levels, and donor-recipient human leukocyte antigen 
      (HLA) mismatch. METHODS: From March 1996 to November 2007, 481 adults undergoing 
      LTx had 3237 serial transbronchial biopsy specimens that were evaluated for 
      perivascular rejection (grade A0 to A4). Longitudinal analysis was used to 
      characterize the prevalence of rejection grade and influence of donor, recipient, 
      technical, and immunologic variables. RESULTS: AR was highest (54%>/=A1) in the 
      first 2 months after LTx, decreased at 6 months (16%>/=A1), then remained steady. 
      Prevalence of AR at any time was dominated by donor-specific factors of young age 
      (p<0.0001), blunt trauma (p=0.008), and nonblack race (p=0.012) and by recipient 
      class II PRA exceeding 10% (p=0.005). AR within 2 months was associated with HLA 
      mismatch at the DR locus (p=0.0006) and use of non-O blood-group donors 
      (p=0.008). AR at 4 years and longer after LTx was associated with HLA mismatch at 
      the B locus (p=0.01). CONCLUSIONS: Only a few recipient and operative factors 
      were identified for AR after LTx. Moderately sensitized recipients identified by 
      class II PRA exceeding 10% and those with HLA mismatches at the B and DR loci 
      appear to be more susceptible to AR; however, such immunologic variations appear 
      to be well controlled with current donor selection and immunosuppression 
      protocols. The impact of donor-specific variables on AR is surprisingly strong 
      and warrants closer inspection.
CI  - Copyright (c) 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Mangi, Abeel A
AU  - Mangi AA
AD  - Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, 
      Cleveland Clinic, Cleveland, Ohio 44195, USA.
FAU - Mason, David P
AU  - Mason DP
FAU - Nowicki, Edward R
AU  - Nowicki ER
FAU - Batizy, Lillian H
AU  - Batizy LH
FAU - Murthy, Sudish C
AU  - Murthy SC
FAU - Pidwell, Diane J
AU  - Pidwell DJ
FAU - Avery, Robin K
AU  - Avery RK
FAU - McCurry, Kenneth R
AU  - McCurry KR
FAU - Pettersson, Gosta B
AU  - Pettersson GB
FAU - Blackstone, Eugene H
AU  - Blackstone EH
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110504
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
RN  - 0 (HLA Antigens)
RN  - 0 (Isoantibodies)
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - Graft Rejection/*etiology
MH  - HLA Antigens/immunology
MH  - Histocompatibility Testing
MH  - Humans
MH  - Isoantibodies/blood
MH  - Lung Transplantation/*adverse effects
MH  - Middle Aged
MH  - Risk Factors
MH  - Tissue Donors
EDAT- 2011/05/04 06:00
MHDA- 2011/08/13 06:00
CRDT- 2011/05/04 06:00
PHST- 2010/08/06 00:00 [received]
PHST- 2011/01/19 00:00 [revised]
PHST- 2011/01/21 00:00 [accepted]
PHST- 2011/05/04 06:00 [entrez]
PHST- 2011/05/04 06:00 [pubmed]
PHST- 2011/08/13 06:00 [medline]
AID - S0003-4975(11)00266-9 [pii]
AID - 10.1016/j.athoracsur.2011.01.076 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2011 Jun;91(6):1754-62. doi: 10.1016/j.athoracsur.2011.01.076. 
      Epub 2011 May 4.