Higher Molecular Injury at Diagnosis of Acute Cellular Rejection Increases the Risk of Lung Allograft Failure: A Clinical Trial

Summary

The abstract reports a multicentre, prospective cohort study of 188 lung transplant recipients with serial plasma donor-derived cell-free DNA (dd-cfDNA) measurements and bronchoscopy. In multivariable analysis, acute cellular rejection (ACR) was associated with the combined outcome of CLAD or death (hazard ratio 2.07, 95 percent confidence interval 1.05 to 4.10). A dd-cfDNA level of at least 1 percent at the time of ACR diagnosis was independently associated with a higher risk of the combined outcome (hazard ratio 3.32, 1.31 to 8.40), and ACR episodes categorised as high risk by this threshold carried an increased risk, whereas low-risk episodes did not. The authors conclude that the risk after ACR may depend on the degree of molecular injury. The abstract gives a clinical trial registration (NCT02423070). The outcome is composite, so the result does not isolate CLAD alone.

Details

doi

10.1164/rccm.202305-0798oc

pmid

38190701

authors

Keller MB, Tian X, Jang MK, Meda R, Charya A, Berry GJ, Marboe CC, Kong H, Ponor IL, Aryal S, Orens JB, Shah PD, Nathan SD, Agbor-Enoh S

journal

American Journal of Respiratory and Critical Care Medicine

year

2024

volume

209

issue

10

pages

1238-1245

Sources and links

• Publisher record via DOI (primary)
• PubMed 38190701

Related

Links from this record

• supports: Donor-derived cell-free DNA

Linked from (derived)

• author affiliation matches this institution (PubMed): Johns Hopkins Lung Transplant Program
• author affiliation matches this institution (PubMed): Stanford Lung Transplant Program
• author affiliation matches this institution (PubMed): Lung Transplant Program, University of Maryland Medical Center

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