Harvard Catalyst Profiles

Outcomes after lung transplantation continue to improve but still lag behind those of other solid organ transplant cohorts. The impact of circulating HLA antibodies on these outcomes remains poorly defined. Lung Transplant candidates with circulating antibodies can experience a post-transplant donor specific memory response which has the potential to impact allograft function. Transplant recipients can also develop donor specific de novo antibodies with the potential to convey allgoraft injury. Methods for detection of HLA antibodies are becoming more sophisticated and sensitive, but specific characteristics of these antibodies that impart injury potential post-transplant remain to be better defined. Despite this, candidates who are sensitized with HLA antibodies often have decreased access to transplantation and longer wait times. The most commonly impacted candidate cohorts include women and other already underserved communities. Our research aims to better understand the risk potential of circulating HLA antibodies in lung transplant candidates and recipients by clarifying the testing methods that are most clearly associated with clinical impact, the antibody characteristics that are most clearly associated with injury potential, and outcomes of transplantation in the setting of donor specific HLA antibodies. The goal of this research is to optimize access to transplantation for candidates who are sensitized but whose HLA profile presents acceptable risk, while optimizing post-transplant outcomes in the sensitized candidate population.