*Purpose: The development of donor specific antibody (DSA) has been correlated to the development of cardiac allograft vasculopathy (CAV) after heart transplantation. However, it has not been discerned whether the characteristics of DSA (persistent, 1:8 dilution, complement binding (C1q) positivity) correlate not only to the development but also the severity of CAV by the ISHLT grading scale. Furthermore, it has been reported that persistent DSA defined as 2 years in a row detecting DSA has an even higher correlation to the development of CAV. We sought to evaluate this association in our large single-center study.

*Methods: Between 2010 and 2014, we evaluated 421 heart transplant patients and divided them into those who were detected to have DSA in the first 5 years after transplant (n=119) and those who did not (control group, n=302). Patients with DSA were further categorized into those with persistent DSA (n=29), those with 1:8 dilution positive DSA (n=39) and those with C1q positive DSA (n=33). These groups were compared to the control group. All categories were then correlated to freedom from CAV (stenosis ≥ 30% by angiography) at 5 years and the degree of CAV as per the ISHLT grading scale.

*Results: 5-year freedom from CAV between all DSA groups and the control group revealed no significant differences. Compared to the control group, patients with DSA, persistent DSA, 1:8 dilution positive DSA, and C1q positive DSA had increased incidence of CAV2/3. The persistent DSA group had the strongest association with the severity of CAV (grade 2/3).

*Conclusions: DSA and various characteristics of DSA appear to be associated with increased severity of CAV (grade 2/3) by ISHLT criteria. Further studies for this categorization of DSA should be considered. It is not known whether treatment of these DSA will alter the CAV course.

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