Abstract 9639: Pre-Transplant Circulating Antibodies Predict Development of Antibody-Mediated Rejection after Heart Transplant Using the New ISHLT Antibody-Mediated Rejection Pathology Grading Scale
Purpose: Pre-transplant circulating antibodies have been associated with the development of antibody mediated rejection (AMR) following heart transplantation. The new pathology antibody mediated rejection scale was developed in 2009 and now the diagnosis of antibody mediated rejection is standardized through this pathology scale. We chose to assess whether pre-transplant circulating antibodies do indeed lead to more pathology antibody mediated rejection according to the new International Society for Heart and Lung Transplantation (ISHLT) AMR grading scale.
Methods: Between January 1, 2010 and July 1, 2011 we evaluated 106 heart transplant recipients for their pre-transplant percentages of peak panel reactive antibody (PRA). Patients were divided into the following subgroups depending on the percentage of peak pre-transplant PRA: peak PRA 0-9% (n = 67), PRA ≥ 10% (n = 39), PRA ≥ 25% (n = 31), PRA ≥ 50% (n = 25), PRA ≥ 75% (n = 19), and PRA = 100% (n = 4). The endpoints of this study were first-year pathology antibody mediated rejection and treated antibody mediated rejection. Treated antibody mediated rejection was mainly due to symptoms of heart failure and or decrease in left ventricular ejection fraction.
Results: Patients with higher pre-transplant PRA's had significantly more pathology antibody mediated rejection in the first-year after heart transplantation compared to patients with a peak PRA 0-9% (see table). The number of treated antibody mediated rejection episodes also increased with higher PRA's, which were also significantly different from the peak PRA 0-9% group.
Conclusion: Pre-transplant circulating antibodies appear to predict pathology antibody mediated rejection according to the most recent ISHLT grading scale. This appears to confirm that pre-transplant circulating antibodies greater than 10% is a threshold for antibody-mediated rejection and therefore consideration for augmentation of immunosuppression should be considered.
- © 2012 by American Heart Association, Inc.