OR3 Development of HLA de novo donor specific antibody is associated with preformed non-HLA autoantibodies and lung transplantation rejection

Aim Autoantibodies have been implicated in the chronic rejection process after Lung Transplantation (LuT), but it is less certain if preformed non-HLA autoantibody (pAuAb) is the pre-LuT determinant for De Novo Donor Specific Antibody (dDSA) development. This study aims to investigate the relationship of pAuAb to dDSA fomation and the clinical impact of dDSA to LuT. Methods 124 recipients underwent LuT during 10/2012 −2/2014 at our center were retrospectively analyzed for dDSA (Mean Fluorescence Intensity ⩾1000). pAuAbs were detected among a subgroup of 118 patients using LABScreen™ Autoantibody (Thermofisher, panel coverage is listed in Table 1a). Cut-offs for pAuAbs were set up using 85% reference background values, which were calculated of lower than 85% population from a group of random selected non-transplanted and non-transfused individuals. Acute Cellular Rejection (ACR), Antibody Mediated Rejection (AMR) were recorded to assess LuT outcomes. Results 71 out of 124 (57%) recipients were identified with dDSA. Among dDSA recipients, Class I only, Class II only, and combined Class I and Class II were 16 (23%), 30 (42%), and 25 (35%), respectively. 53 (75%) of total dDSA was from DQ. pAuAbs to Angiotensinogen and Vimentin were clearly related to the formation of dDSA (p  Conclusions The significant relevance of multiple pAuAbs to the formation of dDSA may provide a new perspective for evaluating the possibility of pAuAbs in eliciting dDSA at pre-LuT, which may help to reduce the risk of ACR and AMR related negative impact to LuT.