Purpose: The natural history of the production of circulating antibodies has not yet been clearly established. Recent technology has allowed for the improved detection of these antibodies. Antibody detection has been correlated to less optimal long term outcome. In our program we have been drawing blood for circulating antibodies at routine time periods including 1, 3, 6, 12 months and yearly after heart transplantation. Knowing when most antibodies develop will allow for appropriate monitoring and potential treatment.

Methods: Between 2010 and 2013, we assessed 193 heart transplant patients who at baseline had no circulating antibodies. Blood for antibodies was drawn at 1, 3, 6 and 12 months after heart transplant and yearly thereafter. Freedom from antibody production was assessed at each time period using Kaplan-Meier analysis.

Results: Most antibodies developed within 1 month after heart transplant in these antibody-naive patients (see circled – figure 1). This held true for both donor specific and non-donor specific antibodies (see circled – figure 2).

Conclusion: Antibody production appears to be most prevalent in the first month after heart transplant and should therefore designate these patients at risk for poor outcome after heart transplant. Strategies to prevent this antibody production should be pursued.

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