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PERIOPERATIVE DESENSITIZATION THERAPY DECREASES ACUTE REJECTION IN SENSITIZED LUNG TRANSPLANT RECIPIENTS.
James Z. Appel, Barbara O. Burgess, Walter F. Herczyk, Ed Cantu, Matthew G. Hartwig, Scott M. Palmer, R. Duane Davis and Nancy L. Reinsmoen. Durham NC, USA, Duke Univeristy Medical Center, 27710, Surgery, Pathology, Pulmonology.

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Purpose: Anti-HLA antibodies have been associated with acute and chronic rejection in lung transplant (LTX) recipients. We evaluated the incidence and severity of acute rejection in sensitized LTX recipients with and without administration of perioperative plasmapheresis and intravenous immunoglobulin (IVIG).
Methods: 36 LTX recipients with pretransplant third party anti-HLA antibodies (confirmed by flow cytometry and negative flow/CDC crossmatches) were analyzed retrospectively. Of these, 14 underwent perioperative desensitization therapy (plasmapheresis/IVIG 500mg/kg daily for 5 days, then IVIG weekly for 3 weeks, then IVIG tapered over 5 months). Surveillance transbronchial biopsies were evaluated posttransplant for evidence of acute rejection (ISHLT grade 0-4).
Results: During the first 12 months posttransplant, patients undergoing desensitization therapy exhibited fewer acute rejection episodes than untreated patients (0.40±0.16 vs 1.10±0.26, p=0.08). The composite score of acute rejection, incorporating ISHLT grade, was significantly lower in patients undergoing desensitization therapy than in untreated patients (0.40±0.22 vs 2.05±0.49, p=0.03). Freedom from acute rejection grades 2-4 was significantly higher in patients undergoing desensitization therapy than in untreated patients (85.7%±9.4 vs 48.5%±11.0, p=0.04) based on log rank analysis.
Conclusions: Administration of plasmapheresis/IVIG to LTX recipients with third party anti-HLA antibodies is associated with a lower incidence and severity of acute rejection during the first 12 months posttransplant. Decreasing the antibody load may promote immune system quiescence.