{"doi":"10.1111/ctr.70241","title":"Long‐Term Chronic Lung Allograft Dysfunction‐Free Survival Following Lung Transplant in the Presence of Donor‐Specific Antibodies","abstract":"BACKGROUND: Highly sensitized patients with advanced lung disease, who are more often Black and Hispanic women, are at increased risk for waitlist death. In 2012, we implemented a protocol to cross any pre-transplant donor-specific antibody (DSA), so long as a prospective complement-dependent cytotoxicity (CDC) crossmatch was negative. We report long-term outcomes, including overall survival and chronic lung allograft dysfunction (CLAD)-free survival. METHODS: This was a single-institution retrospective cohort study of lung transplant recipients between October 1, 2012-December 31, 2022. We compared overall retransplant-free survival and CLAD-free survival between recipients with and without pre-formed DSA. Secondary outcomes included freedom from acute cellular rejection (ACR) and antibody-mediated rejection (AMR). RESULTS: The study cohort included 427 recipients with a median duration of follow-up of 4.3 years (IQR = 2.1-6.9). Thirty-three (7.7%) recipients had pre-transplant DSA with a peak historical mean fluorescence intensity (MFI) of 4200 (IQR = 3000-6600, total range 2100-23 000). The median number of DSA per patient was 1 (IQR = 1-2, total range 1-8). There was no difference in adjusted overall survival between recipients with and without pre-formed DSA (HR = 1.39, 95% CI = 0.82-2.36, p = 0.22) or adjusted CLAD-free survival between recipients with and without pre-formed DSA (HR = 1.07, 95% CI = 0.65-1.75, p = 0.79). Recipients with pre-formed DSA did not have increased adjusted hazard of ACR (HR = 0.71, 95% CI = 0.29-1.75, p = 0.45) but did have increased adjusted hazard of AMR (HR = 5.02, 95% CI = 2.11-11.95, p < 0.001). CONCLUSIONS: In this moderately-sized cohort, a protocol of accepting donor offers for lung transplant candidates with pre-formed DSA but negative CDC crossmatch was not associated with worse overall or CLAD-free survival, within the limitations of the sample size.","journal":"Clinical Transplantation","year":2025,"id":545506,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9534,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":320046,"name":"Andrew Courtwright","orcid":"0000-0001-9511-5975","position":1,"is_corresponding":false},{"id":473193,"name":"Melissa Y. Yeung","orcid":"0000-0002-1130-3192","position":2,"is_corresponding":false},{"id":1273693,"name":"Selvin Jacob","orcid":null,"position":3,"is_corresponding":false},{"id":442127,"name":"Stefi Lee","orcid":"0000-0002-4393-9929","position":4,"is_corresponding":false},{"id":1273192,"name":"Adil Sheikh","orcid":"0000-0003-4173-7896","position":5,"is_corresponding":false},{"id":804665,"name":"Mohamed Keshk","orcid":null,"position":6,"is_corresponding":false},{"id":1436777,"name":"Amy Hackman","orcid":null,"position":7,"is_corresponding":false},{"id":1436778,"name":"Anthony Coppolino","orcid":null,"position":8,"is_corresponding":false},{"id":1436779,"name":"John Dunning","orcid":null,"position":9,"is_corresponding":false},{"id":486016,"name":"Nirmal Sharma","orcid":"0000-0001-6340-4844","position":10,"is_corresponding":false},{"id":320050,"name":"Hilary J. Goldberg","orcid":"0000-0002-2319-0009","position":11,"is_corresponding":false},{"id":388132,"name":"Benjamin Grobman","orcid":"0000-0002-4416-6243","position":0,"is_corresponding":true}],"reference_count":18,"raw_metadata":null,"created_at":"2026-07-19T02:53:23.001995Z","pmid":"40698562","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}