Donor-specific anti-HLA antibodies with antibody-mediated rejection and long-term outcomes following heart transplantation

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:36

Article

Clerkin, Kevin J.¹  Farr, Maryjane A.¹  Restaino, Susan W.¹  Zorn, Emmanuel²  Latif, Farhana¹  Vasilescu, Elena R.³  Marboe, Charles C.³  Colombo, Paolo C.¹  Mancini, Donna M.⁴ 

[1] Columbia Univ Coll Phys & Surg, Dept Med, Div Cardiol, New York, NY USA

[2] Columbia Univ Coll Phys & Surg, Columbia Ctr Translat Immunol, 630 W 168th St, New York, NY 10032 USA

[3] Columbia Univ Coll Phys & Surg, Dept Pathol & Cell Biol, 630 W 168th St, New York, NY 10032 USA

[4] Icahn Sch Med Mt Sinai, Dept Med, Div Cardiol, New York, NY 10029 USA

关键词: antibody mediated rejection;    donor specific antibodies;    heart transplant;    cardiac allograft vasculopathy;    mortality;   

DOI  :  10.1016/j.healun.2016.10.016

来源: Elsevier

【 摘 要 】

BACKGROUND: Donor-specific anti-HLA antibodies (DSA) are common after heart transplantation and are associated with rejection, cardiac allograft vasculopathy, and mortality. A noninvasive diagnostic test for pathologic antibody-mediated rejection (pAMR) does not exist. METHODS: From January 1, 2010, through August 31, 2013, 221 consecutive adult patients underwent heart transplantation and were followed through October 1, 2015. The primary objective was to determine whether the presence of DSA could detect AMR at the time of pathologic diagnosis. Secondary analyses included association of DSA (stratified by major histocompatibility complex class and de novo status) during AMR with new graft dysfunction, graft loss (mortality or retransplantation), and development of cardiac allograft vasculopathy. RESULTS: During the study period, 69 patients (31.2%) had DSA (24% had de novo DSA), and there were 74 episodes of pAMR in 38 patients. Sensitivity of DSA at any mean fluorescence intensity to detect concurrent pAMR was only 54.3%. The presence of any DSA during pAMR increased the odds of graft dysfunction (odds ratio = 5.37; 95% confidence interval [CI], 1.34-21.47; p = 0.018), adjusting for age, sex, and timing of AMR. Circulating class II DSA after transplantation increased risk of future pAMR (hazard ratio = 2.97; 95% CI, 1.31-6.73; p = 0.009). Patients who developed de novo class II DSA had 151% increased risk of graft loss (contingent on 30-day survival) compared with patients who did not have DSA (95% CI, 1.11-5.69; p = 0.027). CONCLUSIONS: DSA were inadequate to diagnose pAMR. Class II DSA provided prognostic information regarding future pAMR, graft dysfunction with pAMR, and graft loss. (C) 2017 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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