ORIGINAL RESEARCH
Transpl. Int.
Efficacy of Intravenous Immunoglobulin in Eliminating De Novo Donor-Specific Antibodies After Lung Transplantation: Importance of Early Intervention
Maximilian Vorstandlechner 1
Philip Degenfelder 1
Gökce Yavuz 1
Olaf Michael Glueck 1
Julia Regina Kovács 1
Julia Walter 1,2
Andrea Dick 3
Sebastian Michel 4,5,6
Christian Peter Schneider 1,6,5
Michael Zoller 7
Jürgen Barton 2,5
Teresa Kauke 1,6,5
1. Division of Thoracic Surgery, University Hospital of Munich, LMU, Munich, Germany
2. Department of Medicine V, University Hospital of Munich, LMU, Munich, Germany
3. Laboratory for Immunogenetics, Division of Transfusion Medicine, Cell Therapeutics and Haemostaseology, University Hospital of Munich, LMU, Munich, Germany
4. Department of Cardiac Surgery, University Hospital of Munich, LMU, Munich, Germany
5. Transplantation Center, University Hospital of Munich, LMU, Munich, Germany
6. Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
7. Department of Anesthesiology, University Hospital of Munich, LMU, Munich, Germany
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Abstract
Background: The development of de novo donor-specific anti-HLA antibodies (dnDSA) after lung transplantation (LuTX) has been increasingly linked to the onset of antibody-mediated rejection (AMR), chronic lung allograft dysfunction (CLAD), and impaired long-term outcomes. However, the therapeutic impact of intravenous immunoglobulin (IVIG) therapy in patients with dnDSA remains unclear. Methods: We conducted a retrospective single-center study of LuTX recipients (2015–2019) who developed dnDSA post-transplantation and received IVIG-based therapy. Patients were classified as responders or non-responders based on post-treatment antibody clearance. Clinical, immunological and functional outcomes were compared. Results: Among 47 patients with dnDSA and IVIG-based therapy, 23 (48.9 %) achieved complete antibody elimination. Preemptive treatment, defined as initiation of IVIG therapy before onset of clinical symptoms, was found to be an independent predictor of antibody clearance (odds ratio 29.5; p = 0.013). Responders showed significantly lower baseline MFI. While differences in CLAD-free survival favored responders, they did not reach statistical significance. Conclusions: Preemptive IVIG therapy in asymptomatic dnDSA-positive LuTX recipients may enhance antibody clearance and reduce CLAD risk. These findings support early intervention strategies and underscore the need for prospective trials to define optimal therapeutic thresholds and timing.
Summary
Keywords
lung transplantation, dnDSA, AMR, ACR, CLAD
Received
30 July 2025
Accepted
20 October 2025
Copyright
© 2025 Vorstandlechner, Degenfelder, Yavuz, Glueck, Kovács, Walter, Dick, Michel, Schneider, Zoller, Barton and Kauke. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Maximilian Vorstandlechner, max.vorstandlechner@med.uni-muenchen.de
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