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. 2025 Sep 22:38:15040.
doi: 10.3389/ti.2025.15040. eCollection 2025.

Long Term Outcomes of Lung Transplantation in Sensitized Patients Following Eculizumab Use With the Desensitization Protocol

Yudai Miyashita  1 , Taisuke Kaiho  1 , David F Pinelli  2 , Anthony Joudi  3 , Mihir John  3 , Austin Chang  1 , Benjamin Louis Thomae  1 , Amanda Kamar  3 , Carl Atkinson  3 , Ankit Bharat  1 , G R Scott Budinger  3 , Ambalavanan Arunachalam  3 , Chitaru Kurihara  1
Affiliations

Long Term Outcomes of Lung Transplantation in Sensitized Patients Following Eculizumab Use With the Desensitization Protocol

Yudai Miyashita et al. Transpl Int. .

Abstract

Lung transplantation remains a life-saving option for end-stage pulmonary diseases, but sensitized patients with anti HLA antibodies carry high risk; recent desensitization advances, such as eculizumab, may permit outcomes comparable to non-sensitized recipients with tailored perioperative care. In this prospective cohort study of 399 adult lung transplant recipients, 36 sensitized patients underwent a protocol combining preoperative plasmapheresis, a defined eculizumab regimen, anti-thymocyte globulin, and IVIG. In comparison, 363 non-sensitized recipients received standard immunosuppression. We compared recipient/donor characteristics, intraoperative parameters, and postoperative outcomes, including primary graft dysfunction, infection, rejection, and overall survival. Desensitized patients were older, predominantly female, and had significantly higher panel reactive antibody levels and preformed donor-specific antibodies; intraoperatively, they required more blood transfusions and VA-ECMO support. Postoperatively, they exhibited higher rates of de novo donor-specific antibodies, antibody-mediated rejection, longer ICU stays, increased dialysis requirement, and more frequent CMV infections. Despite these differences, rates of acute cellular rejection, chronic lung allograft dysfunction, and one-year and overall survival were similar between groups. Our findings suggest that lung transplantation in sensitized patients managed with a desensitization protocol, including eculizumab, is feasible and safe, achieving outcomes comparable to those of non-sensitized recipients.

Keywords: ACR; AMR; eculizumab; lung transplantation; sensitized.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier curves comparing outcomes after lung transplantation by use of a perioperative desensitization protocol (red, No; blue, Yes). (A) Respiratory infection–free survival (log-rank p=0.93). (B) Cytomegalovirus (CMV) infection–free survival (p<0.0001). LTx, lung transplantation.
FIGURE 2
FIGURE 2
Rejection outcomes by desensitization status. Kaplan–Meier estimates of (A) ACR-free survival and (B) AMR-free survival after LTx (red, No; blue, Yes). Log-rank p-values are shown on each panel; tick marks indicate censoring. Numbers at risk are provided below the x-axis.
FIGURE 3
FIGURE 3
Overall survival after lung transplantation according to desensitization protocol (red, No; blue, Yes). Kaplan–Meier curves with numbers at risk shown below; tick marks indicate censoring. Log-rank p=0.83.
See this image and copyright information in PMC

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