Abstract 10549: Comparison of Maintenance Immunosuppression and de novo Antibody Production in the First-Year After Heart Transplant
BACKGROUND: Improved outcomes following heart transplantation in recent years have been chiefly attributed to advances in immunosuppression. The purpose of the current study was to determine the impact of the choice of maintenance immunosuppression on antibody production after heart transplantation.
METHODS: We reviewed 229 first-time heart transplant recipients for the development of de novo HLA antibodies by flow panel reactive antibodies (PRA) in the first year after transplantation. Patients were stratified by maintenance immunosuppression: cyclosporine/mycophenolate mofetil (29 patients); tacrolimus/mycophenolate mofetil (181 patients) and cyclosporine/everolimus (19 patients). We assessed the development of de novo donor-specific antibodies and nonspecific antibodies, as well as peak first-year panel reactive antibodies.
RESULTS: De novo donor specific antibody production was significantly higher in the cyclosporine/mycophenolate mofetil group (3/29 (10%)) vs the tacrolimus/mycophenolate mofetil group (5/181 pts (3%))(P<0.05%). No cyclosporine/everolimus patients developed donor specific antibodies. The peak PRA during the 1st year was significantly higher in the cyclosporine/mycophenolate mofetil group (42%±19%) compared to the cyclosporine/everolimus group (19%; p<0.05).
CONCLUSIONS: The use of tacrolimus compared to cyclosporine in conjunction with mycophenolate mofetil in heart transplantation is associated with decreased de novo production of donor-specific antibodies. Everolimus may be the most effective at attenuating antibody production although the numbers are small. Further study in a larger cohort of patients is necessary to confirm these findings.
- © 2013 by American Heart Association, Inc.