The Overriding Importance of HLA-DR Donor-Specific Antibody That is Correlated to CAV after Heart Transplant
Cedars Sinai Medical Center, Los Angeles.
Meeting: 2018 American Transplant Congress
Abstract number: B39
Keywords: Heart transplant patients, HLA-DR allopeptides, Vascular disease
Session Information
Session Name: Poster Session B: Heart and VADs: All Topics
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Purpose: Class II donor specific anti-HLA antibodies (DSA) have been correlated to subsequent CAV development. More specifically, HLA-DQ has been most reported for CAV development. Recently, HLA-DP has been added to the UNET computer. In this recent era, we are now able to compare class II antibodies to one another and assess outcome. We chose to evaluate our HTx patients who developed class II DSA in the first year after transplant.
Methods: Between 2007 and 2014 we assessed 100 HTx patients who developed class II DSA in the first year. Patients were divided into HLA-DP, DQ, DR DSAs and if there were overlap of class II DSA, then according to the immunodominant DSA by MFI. In our program, we routinely assess for circulating antibodies at baseline, 1, 3, 6, 12 months after HTx. First year class II DSA groups were then correlated to 3-year freedom from CAV, 3-year survival, and 3-year freedom from NF-MACE (myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke). In addition, the groups were assessed for 3-year freedom from any-treated rejection (ATR), acute cellular rejection (ACR) and antibody-mediated rejection (AMR).
Results: First-year HLA-DR DSA had a significantly lower freedom from 3-year CAV compared to the other two groups. 3-year survival, 3-year freedom from NF-MACE, ATR, ACR and AMR were similar among the three groups. Specifically, HLA-DQ DSA had significantly greater freedom from CAV compared to HLA-DR DSA (91.4% vs 66.4%, p=0.009).
Conclusion: Contrary to current belief, first-year HLA-DR DSA appears to be a more important factor leading to the development of CAV at 3 years compared to HLA-DQ DSA. If HLA-DR DSA is detected, one might consider switch to a proliferation signal inhibitor.
| Endpoints | DP (n=2) | DQ (n=85) | DR (n=33) | P-Value |
| 3-Year Survival | 100.0% | 79.6% | 81.6% | 0.807 |
| 3-Year Freedom from CAV | 100.0% | 91.4% | 66.4% | 0.023 |
| 3-Year Freedom from NF-MACE | 100.0% | 92.6% | 83.4% | 0.497 |
| 3-Year Freedom from ATR | 100.0% | 59.7% | 62.3% | 0.608 |
| 3-Year Freedom from ACR | 100.0% | 80.2% | 92.8% | 0.367 |
| 3-Year Freedom from AMR | 100.0% | 86.1% | 86.2% | 0.809 |
CITATION INFORMATION: Kransdorf E., Patel J., Kittleson M., Dimbil S., Levine R., Geft D., Chang D., Czer L., Kobashigawa J. The Overriding Importance of HLA-DR Donor-Specific Antibody That is Correlated to CAV after Heart Transplant Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Kransdorf E, Patel J, Kittleson M, Dimbil S, Levine R, Geft D, Chang D, Czer L, Kobashigawa J. The Overriding Importance of HLA-DR Donor-Specific Antibody That is Correlated to CAV after Heart Transplant [abstract]. https://atcmeetingabstracts.com/abstract/the-overriding-importance-of-hla-dr-donor-specific-antibody-that-is-correlated-to-cav-after-heart-transplant/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress