Purpose: Patients (pts) with prior transplants, blood transfusions, and pregnancies awaiting heart transplantation (HTx) have potential to develop circulating anti-HLA antibodies (HLA Abs). Pts at risk but who do not develop HLA Abs are termed “memory” type pts because they have the potential to mount an Ab response. Those pts with no HLA Abs detected and no risk factors are called “naïve” pts. Whether naïve vs memory vs detected HLA Ab pts have an increased risk for the development of donor-specific antibody (DSA) and/or rejection after the first yr has not been established.

Methods: Between 2010-15 we assessed 502 HTx pts and divided them into naïve (n=199), memory (n=156), and detected HLA Ab pts (n=147). Endpoints included 2-yr survival, development of DSA, 1-yr freedom from any-treated rejection (ATR), 1-year freedom from acute cellular rejection (ACR), 1-yr freedom from antibody mediated rejection (AMR), and 1-yr freedom from biopsy-negative rejection (BNR).

Results: There was no difference in 2-yr survival between the groups. Pts in the detected HLA Ab group had significantly reduced 2-yr freedom from development of DSA vs the naïve group (p<0.001). There was a strong trend towards reduced 2-yr freedom from DSA development in the memory group vs naïve pts (p=0.051). The detected HLA Ab group had a significantly reduced 1-yr freedom from AMR (p=0.003). There was no significant difference in ACR or BNR between the groups.

Conclusion: Memory pts and pts with detectable HLA Abs are at risk of developing DSA post-HTx. These pts may be considered for more intense immunosuppression to potentially reduce post-HTx DSA-related complications.

CITATION INFORMATION: Patel J., Kittleson M., Kransdorf E., Levine R., Dimbil S., Geft D., Chang D., Czer L., Kobashigawa J. Pre-Transplant Memory Patients Even without Detected Antibody Are at Rejection Risk in the First-Year after Heart Transplantation Am J Transplant. 2017;17 (suppl 3).

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