*Purpose: The timing of the development of donor specific antibody (DSA) after heart transplantation is not clear. De novo DSA has been reported to be approximately 13% in the first year following heart transplantation. However, it is known that DSA also develops years after transplantation. There may also be a difference between the development of class 1 versus class 2 DSA and a correlation to various outcomes. Therefore, we sought to evaluate our heart transplant patients to assess the timing of the development of DSA following heart transplantation.

*Methods: Between 2010 and 2013 we assessed 188 heart transplant patients and determined whether or not they developed de novo DSA in year 1, years 2-5, and years >5 following heart transplantation. Blood for antibodies are routinely drawn in our program at 1, 3, 6, and 12 months after transplant and yearly thereafter. At least 1 blood draw for the detection of DSA had to be drawn in each timing category in order to determine the de novo aspect of the development of DSA. These de novo antibodies were subsequently divided into class 1 versus class 2.

*Results: The development of DSA was most prevalent in the first year (12.2%) following heart transplantation. There was an 8-9% incidence of de novo DSA in the ensuing time categories. There appeared to be a prevalence of class 2 versus class 1 antibodies particularly greater than 1 year following heart transplantation.

*Conclusions: DSA is most prevalent in the first year following heart transplantation. De novo DSA is seen later following heart transplantation but appears to be predominantly class 2. Further monitoring will be necessary to assess whether the presence of these late detected DSA is more highly correlated to the development of chronic rejection and/or CAV.

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