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75 Francis Street, PBBCCA3, Boston, MA 02115. E-mail: [email protected] This article has an online supplement, which is accessible from this issue'

s table of contents at www.atsjournals.org Am J Respir Crit Care Med Vol 189, Iss 10, pp 1234C1239, May 15,

2014 Copyright ?

2014 by the American Thoracic Society Originally Published in Press as DOI: 10.1164/rccm.201312-2160OC on April 21,

2014 Internet address: www.atsjournals.org

1234 American Journal of Respiratory and Critical Care Medicine Volume

189 Number

10 | May

15 2014 Lung transplantation can be a life-saving therapy for end-stage lung disease, but many factors affect the likelihood of transplant in the candidate population. The importance of candidate antibodies against HLA is an area of ongoing interest, with implications for access to transplant and post-transplant outcomes. More than 1,600 alleles of HLA class I and II molecules have been described (1), and antibodies can develop on exposure to antigens via various sensitizing events, including transfusion, pregnancy, and prior transplantation (2, 3). The signi?cance of anti-HLA antibodies, whether speci?c to donors or not, has been studied in solid organ transplant recipients (4C10). However, limited data exist regarding the prevalence and impact of pretransplant anti-HLA antibodies in lung transplant candidates. An elevated panel-reactive antibody (PRA) before transplant has been associated with more days on the ventilator after surgery, an increased risk of bronchiolitis obliterans syndrome, and poor post-transplant survival in lung transplant recipients (11C13). Quantitating the amount of anti- HLA antibody using solid-state methods remains problematic. The existing solid- state assays (such as Luminex) are approved by the U.S. Food and Drug Administration for specifying the set of anti-HLA antibodies present but not for quantization of the antibody strength. There is no consensus regarding the appropriate mean ?uorescent intensity (MFI) threshold for identifying anti-HLA antibodies or assessing their impact on the likelihood of transplantation or the development of antibody-mediated rejection (AMR) after transplantation. The objectives of this study were to investigate the prevalence of pretransplant anti-HLA antibodies at varying thresholds in patients awaiting lung transplant and to assess their impact on rates of transplantation and the development of post-transplant AMR. Some of the results of these studies have been previously reported in the form ........