Date: Tuesday, May 5, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Purpose: Donor specific antibodies (DSA) following heart transplant has been reported to be associated with increased development of cardiac allograft vasculopathy (CAV) and risk of mortality following transplantation. In the era of virtual crossmatch, we may now elect to place donor hearts in patients with low level DSAs that are not placed as avoids. The effect of these low level DSAs on the development of CAV has not yet been established.
Methods: Between 1996 and 2012, we evaluated 22 patients who had low levels of DSA with a mean fluorescence intensity (MFI) <5,000 and compared then to patients with no DSA at transplant. Endpoints included 3-year actuarial survival, freedom from CAV, freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, ICD/pacemaker implant, stroke) and freedom from any treated rejection.
Results: 3-Year actuarial survival, freedom from CAV, freedom from NF-MACE, and freedom from any treated rejection in patients with low level DSA at transplant were no different compared to patients with no DSA at transplant. (See table)
|No DSA (n=147)||Low Level DSA at Transplant(n=22)||P-Value|
|3-Year Actuarial Survival||87.8%||94.7%||0.383|
|3-Year Actuarial Freedom from CAV||84.2%||75.0%||0.527|
|3-Year Actuarial Freedom from NF-MACE||86.2%||87.8%||0.673|
|3-Year Actuarial Freedom from Any Treated Rejection||75.2%||78.8%||0.827|
Conclusion: In the era of virtual crossmatch, low level DSA prior to transplant does not appear to be associated with the development of CAV and poor outcomes after heart transplant. These donors, to which the potential recipient has low level DSA, should be considered for transplant. Larger numbers and longer follow-up is needed to confirm these findings.
To cite this abstract in AMA style:Kittleson M, Patel J, Liou F, Siddiqui S, Yabuno J, Chang D, Ramzy D, Czer L, Esmailian F, Reinsmoen N, Kobashigawa J. Is There a Protective Value for Low Level Donor Specific Antibodies to Prevent Cardiac Allograft Vasculopathy After Heart Transplant? [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/is-there-a-protective-value-for-low-level-donor-specific-antibodies-to-prevent-cardiac-allograft-vasculopathy-after-heart-transplant/. Accessed November 25, 2020.
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