EFFECT OF DEVELOPMENT OF ANTIBODIES TO HLA AND CYTOMEGALOVIRUS MISMATCH ON LUNG TRANSPLANTATION SURVIVAL AND DEVELOPMENT OF BRONCHIOLITIS OBLITERANS SYNDROME

Citation
Ma. Smith et al., EFFECT OF DEVELOPMENT OF ANTIBODIES TO HLA AND CYTOMEGALOVIRUS MISMATCH ON LUNG TRANSPLANTATION SURVIVAL AND DEVELOPMENT OF BRONCHIOLITIS OBLITERANS SYNDROME, Journal of thoracic and cardiovascular surgery, 116(5), 1998, pp. 812-819
Citations number
27
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Surgery
ISSN journal
0022-5223
Volume
116
Issue
5
Year of publication
1998
Pages
812 - 819
Database
ISI
SICI code
0022-5223(1998)116:5<812:EODOAT>2.0.ZU;2-R
Abstract
Objective: A retrospective analysis was performed to examine the role of HLA antibodies and cytomegalovirus mismatch on the development of b ronchiolitis obliterans syndrome and survival after lung transplantati on. Methods: Of 339 consecutive lung transplantations pel formed over a 102-month interval, 301 patients survived at least 3 months. There w as a minimum follow-up period of 13 months. Bronchiolitis obliterans s yndrome was defined as a decline in forced expiratory volume in I seco nd less than 80% of posttransplantation baseline and/or histologic pre sence of obliterative bronchiolitis and was defined as occurring ''ear ly'' if documented within 3 years of transplantation. Variables analyz ed included preoperative donor and recipient cytomegalovirus status an d the development of antibodies to human leukocyte antigens after tran splantation. Microcytotoxicity was used to determine the presence of a ntibodies to human leukocyte antigens. Variables were subjected to Kap lan-Meier analysis to determine their impact on freedom from bronchiol itis obliterans syndrome and survival. Results: The development of ant ibodies to human leukocyte antigens after transplantation correlated s ignificantly with bronchiolitis obliterans syndrome (P = .02). The dev elopment of antibodies to human leukocyte antigens did not affect surv ival (P = .33) unless they were detected within 2 years of transplanta tion (P = .04). There was greater frequency of early bronchiolitis obl iterans syndrome in cytomegalovirus seronegative patients who received allografts from seropositive donors compared with all other combinati ons (P = .02). There was also a trend toward worse survival of cytomeg alovirus seronegative patients who received allografts from seropositi ve donors (P = .13). Conclusion: These data suggest that bronchiolitis obliterans syndrome is the result of an immune-mediated process in wh ich HLA antibodies and cytomegalovirus may play a significant role.