Non-HLA Autoantibody-Driven Lung Allograft Injury, Clinical Course, Autoantibody Profiling, and Response to Steroid and Belatacept
Annika Sundlof, Michiko Taniguchi, Rohit Gupta, Mehri Mollaee, Francis Cordova, Kartik Shenoy, Steven Geier, Abdelhamid LiaciniThe presence of HLA donor-specific antibodies (DSAs), both before and after transplantation, is a well-established risk factor for antibody-mediated rejection (AMR) and poor graft survival. However, emerging evidence suggests that non-HLA antibodies may also provoke immune responses, contributing to rejection. Among these, antibodies targeting the angiotensin II type-1 receptor (AT1R) have been linked to adverse clinical outcomes in kidney and orthotopic heart transplant recipients. This case presents an investigation of non-HLA antibodies in a lung transplant recipient diagnosed with AMR in the absence of HLA DSAs, as well as the use of belatacept as part of a combination immunosuppressive regimen to treat AMR in a lung transplant recipient.