Evaluation of a Standardized Treatment Regimen for Antibody Mediated Rejection Following Lung Transplantation

BACKGROUND: The treatment of antibody mediated rejection (AMR) in lung transplant recipients (LTRs) requires a multi-modal approach targeting various pathways in the immune system. There currently is no consensus on what the standard therapy for AMR in LTRs should be. This study evaluates the efficacy of a standardized treatment protocol versus a non-standardized approach. METHODS: This retrospective, single-center study evaluated LTRs treated for AMR with either a standard treatment approach consisting of methylprednisolone, carfilzomib, anti-thymocyte globulin, tocilizumab, and intravenous immunoglobulins or a non-standardized approach. The primary outcome was the incidence of graft loss within 1 year of AMR treatment. Secondary endpoints included the incidence of infections and chronic lung allograft dysfunction (CLAD) within 1 year from AMR treatment. RESULTS: Thirteen patients were included in the standard and 38 patients in the non-standard cohorts. Median time from transplant to AMR was 606 (160-935) days in the standard cohort and 314 (92-541) days in the non-standard cohort (p = 0.125). Graft loss within 1 year from AMR was 30.8% and 39.5% for the standard and non-standard cohorts, respectively (p = 0.416). The incidence of CLAD (69.2% vs 68% [p = 0.619]) and infections (53.8% vs 65.8% [p = 0.504]) were similar in the standard and non-standard cohorts. CONCLUSION: In this retrospective study, there was numerically better 1 year graft survival in the standard cohort vs the non-standard cohort but no difference in incidence of CLAD and infections post AMR.