Importance of Routine Antihuman/Leukocyte Antibody Monitoring
De Novo Donor Specific Antibodies Are Associated With Rejection and Allograft Vasculopathy After Heart Transplantation
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The significance of de novo donor-specific antibodies (dnDSAs) after heart transplantation (HTx) on alloimmune injury, including acute cellular rejection (ACR), antibody-mediated rejection (AMR), and cardiac allograft vasculopathy, remains unclear. In this study, we examined the importance of routine solid-phase arrays in detecting dnDSA during long-term follow-up of recipients of HTx.
The study protocol was approved by the Mayo Clinic Institutional Review Board, and patients gave informed consent. Between January 2009 and December 2013, 86 of 101 consecutive adult recipients of HTx underwent routine serial antihuman leukocyte antigen (HLA) antibody monitoring before and 1 week, 4 months, 1 year, and annually after HTx using a panel of single-antigen beads (LABScreen, One Lambda, Inc.) read on a Luminex (Luminex Corp.) platform. Mean fluorescence intensity levels ≥2000 were considered positive. According to the International Society for Heart and Lung Transplantation classification, 1546 endomyocardial biopsies scored with severe ACR defined as grade 2R or 3R. Serial 3-dimensional intravascular ultrasound examinations were performed as previously published.1 Cumulative incidences were estimated using the Kaplan-Meier method. Cox-proportional hazard models were used for analysis of time-to-event data. Variables with a P value <0.10 by univariable …