Date: Sunday, June 12, 2016
Session Time: 2:30pm-4:00pm
Presentation Time: 3:18pm-3:30pm
Location: Room 309
Background: The development of donor specific antibodies (DSA) after heart transplant has been associated with poor outcome. We now have the ability to assess the functional character of DSA in terms of complement binding. Complement binding DSA may have worse prognosis after heart transplantation, but this has not been well established. We sought to assess the outcome of our heart transplant patients who developed DSA that bind complement in the first year after transplant with subsequent 3-year outcome.
Methods: Between 2010 and 2013 we assessed 341 heart transplant patients. Patients were divided into the following groups: Group A= patients with DSA and complement binding (n=9), Group B= DSA with no complement binding (n=11), Group C= no DSA (n=161). Outcomes included 3-year survival, freedom from cardiac allograft vasculopathy (CAV) as defined by stenosis ≥ 30%, freedom from Non-Fatal Major Adverse Cardiac Events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), and subsequent 1-year freedom from any-treated rejection.
Results: Patients with DSA and complement binding (group A) had significantly lower 3-year survival and freedom from NF-MACE in comparison to the DSA with no complement binding (group B) and no DSA (group C) groups. There was a trend for less freedom from any treated rejection in the DSA groups (group A and B) vs the no DSA group. There was no significant difference in 3-year freedom from CAV among all 3 groups.
Conclusion: DSA development paired with complement binding appears to have significantly worse outcome in survival and NF-MACE. Greater precaution should be taken in monitoring patients with complement fixing DSA. Further investigation and a larger population size are warranted.
DSA + Complement Binding
DSA + No Complement Binding
|3-Year Actuarial Survival||42.9%||100.0%||97.0%*||<.001|
|3-Year Actuarial Freedom from CAV||100.0%||80.0%||80.6%||0.507|
|3-Year Actuarial Freedom from NF-MACE||63.5%||83.3%||91.8%*||0.013|
|3-Year Actuarial Freedom from Any Treated Rejection||66.7%||68.2%||85.9%||0.089|
*p= 0.05 compared to Group A.
CITATION INFORMATION: Patel J, Kittleson M, Chang D, Aintablian T, Velleca A, Ramzy D, Czer L, Kobashigawa J. The Impact of Complement Binding Donor Specific Antibodies in the First Year After Heart Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Patel J, Kittleson M, Chang D, Aintablian T, Velleca A, Ramzy D, Czer L, Kobashigawa J. The Impact of Complement Binding Donor Specific Antibodies in the First Year After Heart Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). http://atcmeetingabstracts.com/abstract/the-impact-of-complement-binding-donor-specific-antibodies-in-the-first-year-after-heart-transplantation/. Accessed January 17, 2018.
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