- Annals of Transplantation. 2000; 5(3):44-7.
OBJECTIVES: Acute and chronic rejection continue to limit the survival of lung transplant recipients. Extracorporeal photopheresis has evolved as a possible therapy for patients with acute nd chronic lung allograft rejection. METHODS: We retrospectively reviewed 14 patients diagnosed with BOS who underwent therapy with extracorporeal photopheresis. RESULTS: Three patients were classified as BOS 0'b', five as BOS 1, three as BOS 2, and, three as BOS 3 at the time of diagnosis. Of the patients with BOS 0'b' or BOS 1 seven remain alive and one died of lung cancer. Two have progressed to BOS 2. Of the patients with BOS 2 or 3, four have died of BOS, one died of lung cancer, and one was re-transplanted. In three patients with BOS and concurrent acute rejection, therapy with extracorporeal photopheresis led to the resolution of the acute rejection episode. Two of the 14 patients developed line related sepsis. CONCLUSION: Extracorporeal photopheresis appears to be a promising therapy for patients with early BOS. It may also have a role in the treatment of acute lung allograft rejection.
BACKGROUND:
There is no standard definition for “HLA incompatible” transplants. For the first time, we systematically assessed how HLA incompatibility was defined in contemporary peer-reviewed publications and its prognostic implication to transplant outcomes.
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METHODS:
We combined 2 independent searches of MEDLINE, EMBASE, and the Cochrane Library from 2015 to 2019. Content-expert reviewers screened for original research on outcomes of HLA-incompatible transplants (defined as allele or molecular mismatch and solid-phase or cell-based assays). We ascertained the completeness of reporting on a predefined set of variables assessing HLA incompatibility, therapies, and outcomes. Given significant heterogeneity, we conducted narrative synthesis and assessed risk of bias in studies examining the association between death-censored graft failure and HLA incompatibility.
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RESULTS:
Of 6656 screened articles, 163 evaluated transplant outcomes by HLA incompatibility. Most articles reported on cytotoxic/flow T-cell crossmatches (n = 98). Molecular genotypes were reported for selected loci at the allele-group level. Sixteen articles reported on epitope compatibility. Pretransplant donor-specific HLA antibodies were often considered (n = 143); yet there was heterogeneity in sample handling, assay procedure, and incomplete reporting on donor-specific HLA antibodies assignment. Induction (n = 129) and maintenance immunosuppression (n = 140) were frequently mentioned but less so rejection treatment (n = 72) and desensitization (n = 70). Studies assessing death-censored graft failure risk by HLA incompatibility were vulnerable to bias in the participant, predictor, and analysis domains.
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CONCLUSIONS:
Optimization of transplant outcomes and personalized care depends on accurate HLA compatibility assessment. Reporting on a standard set of variables will help assess generalizability of research, allow knowledge synthesis, and facilitate international collaboration in clinical trials.
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