Outcomes Following Flow-Cytometry Crossmatch-Positive Lung Transplants Managed With Peri-Operative Desensitization.

Our program previously reported successful outcomes following virtual crossmatch (VXM)-positive lung transplants managed with peri-operative desensitization, but our ability to stratify their immunologic risk was limited without flow-cytometry crossmatch (FCXM) data before 2014. The aim of this study was to determine allograft and chronic lung allograft dysfunction (CLAD)-free survival following VXM-positive/FCXM-positive lung transplants, which are performed at a minority of programs due to the high immunologic risk and lack of data on outcomes1 . All first-time lung transplant recipients between January 2014 and December 2019 were divided into 3 cohorts: VXM-negative (n=764), VXM-positive/FCXM-negative (n=64), and VXM-positive/FCXM-positive (n=74). Allograft and CLAD-free survival were compared using Kaplan-Meier and multivariable Cox proportional hazards models. Five-year allograft survival was 53% in the VXM-negative cohort, 64% in the VXM-positive/FCXM-negative cohort, and 57% in the VXM-positive/FCXM-positive cohort (p=0.7171). Five-year CLAD-free survival was 53% in the VXM-negative cohort, 60% in the VXM-positive/FCXM-negative cohort, and 63% in the VXM-positive/FCXM-positive cohort (p=0.8509). This study confirms that allograft and CLAD-free survival of patients who undergo VXM-positive/FCXM-positive lung transplants with the use of our protocol do not differ from other lung transplant recipients. Our protocol for VXM-positive lung transplants improves access to transplant for sensitized candidates and mitigates even high immunologic risk.