Heart Transplant across Low or Moderate Level Donor-Specific Antibodies Have Acceptable Outcome
Cedars Sinai Medical Center, Los Angeles.
Meeting: 2018 American Transplant Congress
Abstract number: B35
Keywords: Heart/lung transplantation, HLA antibodies, Sensitization
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: The presence of pre-transplant donor specific antibodies (DSA) can reduce the likelihood of a patient (pt) obtaining a compatible donor heart. The proportion of sensitized pts has increased significantly in the recent era. Newer solid phase assays quantify DSA specificity and strength. The development of DSA have been associated with a greater risk of developing antibody mediated rejection (AMR) after heart transplant (HTx). It has not been firmly established if pts transplanted across low-moderate level DSA (MFI<10,000) have been shown to have outcomes comparable to pts with no DSA.
Methods: Between 2008 and 2014 we reviewed the antibody profiles of 514 HTx pts and identified 63 pts with low level DSA (MFI<5,000) and 36 pts with moderate level DSA (MFI 5,000-10,000) at the time of HTx. They were compared with the remaining 415 pts all of whom had no DSA at HTx. All pts with DSA were treated with ATG +/- IVIG. Outcomes assessed included 3-year actuarial survival, freedom from antibody mediated rejection (AMR), freedom from cardiac allograft vasculopathy (CAV) and freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, ICD/pacemaker implant, stroke).
Results: Both low level and moderate level DSA groups had a significantly decreased freedom from AMR at 3-years compared to pts with no DSA at HTx. There was no significant difference in 3-year survival, freedom from CAV, and freedom from NF-MACE between the low level DSA, moderate level DSA and no DSA groups. (See Table)
Conclusion: Transplanting across low level or even moderate level DSA have acceptable outcomes after HTx despite the increased risk of developing AMR. Although further evaluation is needed, this could increase the donor pool for many moderately sensitized pts awaiting HTx.
| Low Level DSA at Transplant (n=63) | Moderate Level DSA at Transplant (n=36) | No DSA at Transplant (n=415) | P-Value | |
| 3-Year Survival | 79.8% | 85.9% | 82.5% | 0.837 |
| 3-Year Freedom from AMR | 87.0% | 83.2% | 98.0% | <0.001 |
| 3-Year Freedom from CAV | 78.5% | 87.5% | 82.9% | 0.716 |
| 3-Year Freedom from NF-MACE | 89.8% | 88.3% | 90.9% | 0.887 |
CITATION INFORMATION: Olymbios M., Patel J., Levine R., Dimbil S., Kittleson M., Rafiei M., Zhang X., Kobashigawa J. Heart Transplant across Low or Moderate Level Donor-Specific Antibodies Have Acceptable Outcome Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Olymbios M, Patel J, Levine R, Dimbil S, Kittleson M, Rafiei M, Zhang X, Kobashigawa J. Heart Transplant across Low or Moderate Level Donor-Specific Antibodies Have Acceptable Outcome [abstract]. https://atcmeetingabstracts.com/abstract/heart-transplant-across-low-or-moderate-level-donor-specific-antibodies-have-acceptable-outcome/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress