Abstract 17155: The Development of De Novo Donor Specific Antibodies is Associated With Higher Rejection Risk After Heart Transplantation
Introduction: There is controversy regarding monitoring patients after heart transplantation (HTX) for development of de novo donor specific anti-human leucocyte antibodies (dnDSA) measured by solid phase arrays due to limited data on its impact on clinical outcomes.
Hypothesis: The objective of this study was to examine the association between dnDSA that were detected on routine surveillance testing and clinical outcomes after HTX.
Methods: Adult patients undergoing HTX from January 2009 to December 2013 had anti-HLA measured at regular intervals post HTX by LABScreen® Single Antigen Beads and read on a Luminex platform. DSA levels with mean fluorescence intensity ≥ 2000 were considered positive. Subjects were sub-classified based on the development of class I or II dnDSA. All endomyocardial biopsy results were retrieved and rejection-free survivals from transplant to first episode of rejection were analyzed with Log-rank test as well as Cox-proportional hazard model in multivariate analyses. Standard definition for antibody mediated rejection (AMR) was used and acute cellular rejection (ACR) grade 2R or more was considered severe.
Results: Amongst 86 HTX recipients, 29 (33.7%) developed dnDSA. Patients with class I dnDSA as compared to patients without class I dnDSA had significantly worse rejection-free survival for AMR (28.6% vs 85.7% at 5 years, p<0.001). Patients with class II dnDSA as compared to those without class II dnDSA had worse severe ACR-free survival (52% vs 75.8% at 5 years, p=0.015). Multivariate analysis revealed class I dnDSA to be independently associated with an increased risk for AMR (HR=5.520, p=0.008) while class II dnDSA was independently associated with increased risk of severe ACR (HR=3.140, p=0.013).
Conclusions: This study highlights the importance of measuring anti-HLA after HTX. The development of class I and class II dnDSAs were independently associated with AMR and severe ACR respectively. Strategies to treat HTx recipients with dnDSA need to be developed to improve clinical outcomes.
Author Disclosures: K. Wong: None. M. Valero Masa: None. T. Taner: None. R. Daly: None. S. Kushwaha: None. N. Pereira: None.
- © 2016 by American Heart Association, Inc.