Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Purpose: Development of donor-specific antibodies (DSA) following heart transplantation (HTx) impacts rejection, cardiac allograft vasculopathy (CAV), and survival. In addition, the timing of Ab development (i.e. early or late) and DSA class may impact outcome. We sought to assess early vs late DSA development and the impact of DSA class on short and long-term outcome following HTx. Circulating DSA are drawn routinely in our program at 1, 3, 6, and 12 months post-HTx and annually thereafter.
Methods: Between 2010-14 we identified 89 pts who developed DSA early (≤ 1 yr) and 42 pts who developed DSA late (> 1 yr). Endpoints included subsequent 1-yr survival, 1-yr freedom from rejection and infection, 3-yr freedom from CAV (defined by ≥ 30% angiographic stenosis).
Results: Late DSA compared to early DSA development led to significantly lower freedom from 1-yr any-treated rejection (p=0.03), and 3-yr CAV (p=0.012) (see table). There was a trend towards reduced freedom from 1-yr acute cellular rejection in the late DSA group (p=0.083). There was no difference in 1-yr survival and 1-yr freedom from antibody-mediated rejection between early vs late DSA groups. Late Class II DSA compared to early Class II DSA had significantly lower freedom from 3-yr CAV (75% vs 90%, p=0.004) (Data not shown).
Conclusion: Late DSA (especially Class II) development is associated with an increased risk for CAV. Aggressive augmentation of immunosuppression (specifically switch to a proliferation signal inhibitor) may be of value for these pts.
|Endpoints||Early DSA Development (n=89)||Late DSA Development (n=42)||Log-Rank P-Value|
|Subsequent 1-Year Survival||92.1%||88.1%||0.359|
|Subsequent 1-Year Freedom from Any-Treated Rejection||70.8%||54.8%||0.030|
|Subsequent 1-Year Freedom from Acute Cellular Rejection||86.5%||76.2%||0.083|
|Subsequent 1-Year Freedom from Antibody-Mediated Rejection||86.5%||85.7%||0.816|
|Subsequent 1-Year Freedom from Infection||36.8%||21.4%||0.028|
|Subsequent 3-Year Freedom from CAV||86.5%||76.2%||0.012|
|*mixed Class I/Class II antibodies excluded|
CITATION INFORMATION: Kransdorf E., Patel J., Kittleson M., Levine R., Dimbil S., Geft D., Chang D., Czer L., Kobashigawa J. Late Donor-Specific Antibody (Especially Class II) Development is Associated with an Increased Risk for Cardiac Allograft Vasculopathy Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Kransdorf E, Patel J, Kittleson M, Levine R, Dimbil S, Geft D, Chang D, Czer L, Kobashigawa J. Late Donor-Specific Antibody (Especially Class II) Development is Associated with an Increased Risk for Cardiac Allograft Vasculopathy [abstract]. https://atcmeetingabstracts.com/abstract/late-donor-specific-antibody-especially-class-ii-development-is-associated-with-an-increased-risk-for-cardiac-allograft-vasculopathy/. Accessed January 25, 2020.
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