BACKGROUND: According to the 2012 ISHLT Registry, two-thirds of patients at the time of transplant do not have circulating antibodies. For these non-sensitized patients, the incidence of post-transplant de novo antibody production has not been firmly established. Its impact on outcome in patients on routine triple drug immunosuppression has also not been determined.

METHODS: Between 2006 and 2011, we evaluated 133 non-sensitized heart transplant patients for the development of de novo circulating antibodies [both nonspecific and donor-specific antibodies (DSA)] in the first year after transplant. Blood for detection of circulating antibodies are routinely drawn at 1,3,6,12 months after heart transplant. Post-transplant outcomes assessed included 3-year survival, freedom from cardiac allograft vasculopathy (CAV), 1-year treated cellular rejection (CR) and antibody-mediated rejection (AMR).

RESULTS: Of the 133 non-sensitized heart transplant patients, the development of non-specific antibodies was detected in 29 (22%) patients, DSA in 10 (7.5%) patients and no antibodies in 94 (70.5%) patients. Patients with first-year DSA had significantly lower survival and a trend for less freedom from CAV. The DSA and non-specific antibody groups had less freedom from first-year treated AMR.

CONCLUSION: Non-sensitized pre-transplant patients who developed first year DSA after transplant have poor outcome. Treatment of these patients with anti-humoral therapies appears warranted, but merits a randomized trial.

Reinsmoen, N.: Speaker’s Bureau, One Lambda.

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