Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Heart transplantation (HT) remains the gold standard treatment for end-stage heart failure. Despite significant improvements in short-term outcomes, the median survival after heart transplantation is less than 13 years. A prior study showed that recipients of donor hearts with HLA mismatches at particular Class II DQ loci were at increased risk of immune-mediated adverse events. These particular HLA mismatches are termed “risk epitope mismatch” (REM). We sought to assess whether REM is associated with incidence of primary graft dysfunction (PGD), cardiac allograft vasculopathy (CAV) and overall mortality.
*Methods: Retrospective analysis including all consecutive adult HT recipients from 2008-2018 in a single institution. Recipients were classified as REM in the presence of donor and recipient mismatch structural epitopes (either DQA5-DQB2 and DQA5-DQB7). Outcomes included post HT mortality, severe PGD, moderate to severe CAV (by ISHLT). Kaplan-Meier method was used for survival analysis. Multivariate regression was used for the outcome of severe PGD and moderate/severe CAV (by ISHLT criteria).
*Results: In a cohort of 449 patients with a median follow up 2.7 (IQR 1-5) years, median age was 56.6 (IQR 47.2-67.9) years, 72% were male (n=320) and 56.4% Caucasian. When stratified by group, 260 (57.9%) had no REM and 189 (42.1%) had REM. Mismatch was more common among female recipients (24% vs. 34%, p=0.024), female donors (40% vs. 34.4, p=0.027) and older donors (34 vs. 32 years, p=0.015). When adjusted for baseline recipient (age, sex, race) and donor (age, sex, race) characteristics and time post HT, REM did not predict either severe PGD (OR 0.53, 95% CI 0.18-1.60) or moderate/severe CAV (OR 0.62, 95% CI 0.11-3.60). There was no difference in 5 year survival between groups (81.9% in the REM and 79.3% no REM groups, log rank p= 0.48).
*Conclusions: Risk Epitope Mismatch was not a predictor of primary graft dysfunction, cardiac allograft vasculopathy, or 5-year survival after HT. Unlike previous studies, we did not find that REM resulted in increased overall mortality. The incidence of de novo donor specific antibodies are needed to assess the true impact of REM and further guide clinical practice.
To cite this abstract in AMA style:Moayedi Y, McCaughan J, Henricksen E, Mueller B, Fan S, Ross HJ, Khush K, Zhang BM, Teuteberg J. Risk Epitope Mismatch Does Not Predict Short Term Heart Transplant Outcomes [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-epitope-mismatch-does-not-predict-short-term-heart-transplant-outcomes/. Accessed October 24, 2020.
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