TY - JOUR
T1 - Center variability in the prognostic value of a cumulative acute cellular rejection “A-score” for long-term lung transplant outcomes
AU - Belousova, Natalia
AU - Huszti, Ella
AU - Li, Qixuan
AU - Vasileva, Anastasiia
AU - Ghany, Rasheed
AU - Gabarin, Ramy
AU - El Sanharawi, Moustapha
AU - Picard, Clement
AU - Hwang, David
AU - Levy, Liran
AU - Keshavjee, Shaf
AU - Chow, Chung Wai
AU - Roux, Antoine
AU - Martinu, Tereza
N1 - Publisher Copyright:
© 2023 American Society of Transplantation & American Society of Transplant Surgeons
PY - 2024/1
Y1 - 2024/1
N2 - The acute rejection score (A-score) in lung transplant recipients, calculated as the average of acute cellular rejection A-grades across transbronchial biopsies, summarizes the cumulative burden of rejection over time. We assessed the association between A-score and transplant outcomes in 2 geographically distinct cohorts. The primary cohort included 772 double lung transplant recipients. The analysis was repeated in 300 patients from an independent comparison cohort. Time-dependent multivariable Cox models were constructed to evaluate the association between A-score and chronic lung allograft dysfunction or graft failure. Landmark analyses were performed with A-score calculated at 6 and 12 months posttransplant. In the primary cohort, no association was found between A-score and graft outcome. However, in the comparison cohort, time-dependent A-score was associated with chronic lung allograft dysfunction both as a time-dependent variable (hazard ratio, 1.51; P < .01) and when calculated at 6 months posttransplant (hazard ratio, 1.355; P = .031). The A-score can be a useful predictor of lung transplant outcomes in some settings but is not generalizable across all centers; its utility as a prognostication tool is therefore limited.
AB - The acute rejection score (A-score) in lung transplant recipients, calculated as the average of acute cellular rejection A-grades across transbronchial biopsies, summarizes the cumulative burden of rejection over time. We assessed the association between A-score and transplant outcomes in 2 geographically distinct cohorts. The primary cohort included 772 double lung transplant recipients. The analysis was repeated in 300 patients from an independent comparison cohort. Time-dependent multivariable Cox models were constructed to evaluate the association between A-score and chronic lung allograft dysfunction or graft failure. Landmark analyses were performed with A-score calculated at 6 and 12 months posttransplant. In the primary cohort, no association was found between A-score and graft outcome. However, in the comparison cohort, time-dependent A-score was associated with chronic lung allograft dysfunction both as a time-dependent variable (hazard ratio, 1.51; P < .01) and when calculated at 6 months posttransplant (hazard ratio, 1.355; P = .031). The A-score can be a useful predictor of lung transplant outcomes in some settings but is not generalizable across all centers; its utility as a prognostication tool is therefore limited.
KW - A-score
KW - CLAD
KW - acute rejection score
KW - chronic lung allograft dysfunction
KW - lung transplant
KW - prognosis
UR - http://www.scopus.com/inward/record.url?scp=85174711050&partnerID=8YFLogxK
U2 - 10.1016/j.ajt.2023.08.014
DO - 10.1016/j.ajt.2023.08.014
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C2 - 37625646
AN - SCOPUS:85174711050
SN - 1600-6135
VL - 24
SP - 89
EP - 103
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 1
ER -