The following is a summary of “Pseudomonas aeruginosa infection correlates with high MFI donor-specific antibody development following lung transplantation with consequential graft loss and shortened CLAD-free survival,” published in the July 2024 issue of Pulmonology by Bogyó et al.
Donor-specific antibodies (DSAs) frequently develop following lung transplantation (LuTx), yet their precise role in graft damage remains ambiguous. The mean fluorescent intensity (MFI) is the primary measure for DSA diagnostics. However, its significance is often overlooked in assessing adverse post-transplant outcomes, such as graft loss or chronic lung allograft dysfunction (CLAD). This study aims to evaluate an MFI stratification method for these outcomes. In a cohort of 87 LuTx recipients, a cutoff of 8000 MFI was established to categorize high MFI based on clinically relevant data. Recipients were divided into three subgroups: DSA-negative, DSA-low, and DSA-high.
Both graft survival and CLAD-free survival were assessed. Additionally, the potential contribution of Pseudomonas aeruginosa (P. aeruginosa) infection, as detected in bronchoalveolar lavage (BAL) specimens, to DSA development was analyzed. The findings revealed that high MFI DSAs significantly contributed to clinical antibody-mediated rejection (AMR) and were associated with markedly worse graft survival (HR: 5.77, p < 0.0001) and CLAD-free survival (HR: 6.47, p = 0.019) compared to low or negative MFI DSA levels. Furthermore, BAL specimen analysis demonstrated a strong correlation between DSA status, P. aeruginosa infection, and BAL neutrophilia. High DSA status and clinical AMR emerged as independent predictors of reduced graft and CLAD-free survival in multivariate Cox regression models. At the same time, BAL neutrophilia was linked to poorer graft survival.
These results suggest that P. aeruginosa infection rates are elevated in recipients with a robust DSA response. The study underscores that simultaneous interpretation of MFI values and BAL neutrophilia presents a viable approach for risk evaluation. This combined assessment may guide clinicians in initiating DSA desensitization therapy promptly, potentially improving patient prognosis by facilitating early intervention.
Source: respiratory-research.biomedcentral.com/articles/10.1186/s12931-024-02868-1
