Center variability in the prognostic value of a cumulative acute cellular rejection “A-score” for long-term lung transplant outcomes

Natalia Belousova*, Ella Huszti, Qixuan Li, Anastasiia Vasileva, Rasheed Ghany, Ramy Gabarin, Moustapha El Sanharawi, Clement Picard, David Hwang, Liran Levy, Shaf Keshavjee, Chung Wai Chow, Antoine Roux, Tereza Martinu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)89-103
Number of pages15
JournalAmerican Journal of Transplantation
Volume24
Issue number1
DOIs
StatePublished - Jan 2024

Funding

FundersFunder number
APCBio Innovations, Inc
Biotest France
Sanofi, Inc
Thorasys Medical Device Inc
Canadian Institutes of Health Research
Natural Sciences and Engineering Research Council of Canada
Lung Health Foundation

    Keywords

    • A-score
    • CLAD
    • acute rejection score
    • chronic lung allograft dysfunction
    • lung transplant
    • prognosis

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