Anti-HLA Antibodies in Lung Transplantation

Abstract

(1) Background: Lung transplantation is an increasingly utilized treatment for end-stage lung disease. Scarcity of organ donors limiting transplantation underscores the importance of optimal histocompatibility testing approaches to facilitate organ allocation and avoid immunologic rejection. Significant data has emerged over the past decade to define the role of alloantibodies against HLA in the pathogenesis of post-lung transplant complications. (2) Methods: Medical literature from 1996–2016 related to search term “lung transplant” was reviewed using PubMed. (3) Results: Review of published literature demonstrated a progressive understanding of the contributions of anti-HLA antibodies to antibody-mediated rejection, bronchiolitis obliterans syndrome, and chronic lung allograft dysfunction. This coincided with implementation of refined histocompatibility testing methods with improved sensitivity and specificity. (4) Conclusions: Antibodies against donor-specific HLA (DSA) contribute to the pathogenesis of immune-mediated complications after lung transplantation. Detection of DSA in peripheral blood is associated with poor outcomes. Current histocompatibility methods have improved prognostic and diagnostic testing to assist directing patient care.