Non-HLA Autoantibody-Driven Lung Allograft Injury, Clinical Course, Autoantibody Profiling, and Response to Steroid and Belatacept

The 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.