Impact of Pseudomonas Aeruginosa Infections and Donor-Specific Antibody Development on Outcomes post-Lung Transplantation: Evaluation and Insights into the Development of the Hungarian Lung Transplantation Program
Bogyó Levente Zoltán
KÁROLY RÁCZ CONSERVATIVE MEDICINE PROGRAM
Dr. Fekete Andrea
Országos Onkológiai Intézet, Előadóterem 3. épület fsz.
2025-10-21 14:20:00
Pulmonology
Dr. Losonczy György
Dr. Bogos Krisztina
Dr. Piros László
Dr. Buzás András
Dr. Zima Endre
Dr. Huszty Gergely Dénes
Dr. Dede Kristóf
Dr. Sótonyi Péter
Annually, between 4.500 and 5.000 lung transplants are performed worldwide, with approximately 55% occurring in North America and about 36% in Europe. The Hungarian program, classified as a low-volume centre, has demonstrated a slow but steady growth in its first three years, although its survival outcomes have slightly lagged behind the averages reported by the ISHLT.
Our objective was to analyse the first three years of clinical data and identify the factors contributing to lower survival rates. We assessed outcomes for the first 62 patients who underwent lung transplantation at our centre, focusing on the correlations between infectious/immunological parameters and survival. This retrospective cohort study included systematic data validation and the analysis of RWD regarding waitlist management, donor activity, and recipient outcomes. We conducted descriptive and multivariate statistical analyses to identify predictors of survival and morbidity, as well as to evaluate early trends. The rates of PGD and acute kidney injury were low, as were bronchial complications, while both ICU and MV times exceeded international benchmarks. In the RWD subgroup analysis, short survival was associated with longer MV and ICU stays, as well as a higher prevalence of high MFI DSAs and clinical AMR. Furthermore, P. aeruginosa infection and high BAL neutrophilia were more strongly correlated with CLAD than with early mortality. In the second part we explored the relationship between airway infections and DSA responses using MFI stratification. We correlated DSAs, BAL immune profiles, and clinical AMR with graft loss and CLAD-free survival. Clinical AMR was identified as an independent risk factor for both graft loss and CLAD; however, subclinical AMR did not have the same impact. High MFI DSAs were associated with reduced CLAD-free survival, while low MFI DSAs did not exhibit a similar effect. A significant correlation was also found between P. aeruginosa infection and the emergence of immunologically high-risk DSAs, as well as between BAL neutrophilia, AMR, CLAD, and survival outcomes. Our findings suggest a potential therapeutic window between the appearance of DSA and the onset of CLAD, indicating that improved monitoring and management may enhance survival rates.
Our research provides a critical evaluation of the Hungarian Lung Transplant Program’s early phase, identifying actionable areas for clinical improvement to boost outcomes and program success.
