Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Purpose: Several reports have correlated the development of donor-specific antibody (DSA) to the development of cardiac allograft vasculopathy (CAV) after heart transplantation (HTx). Interestingly, patients (pts) who develop pathology antibody-mediated rejection (pAMR) by EMB do not always have detectable DSA at the time of the rejection episode. It is not known whether the combination of pAMR plus DSA in the first-year after transplant leads to a greater incidence of subsequent CAV. We sought to assess the impact of first-year pAMR and DSA on the subsequent development of CAV by angiography at 3-years post-HTx.
Methods: Between 2010-14 we assessed 400 HTx pts and divided them into those pts with first-year pAMR and DSA (n=31), pts with pAMR alone (n=53), pts with DSA alone (n=53) and pts who did not develop pAMR or DSA (n=263), We analyzed these groups for the development of 3-year CAV via angiography (per the ISHLT CAV grading scale). Additional endpoints included 3-year survival, and 3-year freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, and stroke).
Results: There was no difference in survival between the four groups. There was significantly less freedom from 3-year angiographic CAV noted in pts with pAMR and DSA (71.0% vs 92.2% vs 92.5% vs 87.1%, p=0.043, see table). Pts who had pAMR alone had similar outcomes in terms of angiographic CAV compared to pts without pAMR in the first-year post-transplant. Pts with DSA alone had similar outcomes compared to pts without DSA.
Conclusion: It appears that the combination of DSA and pAMR increases the risk of subsequent CAV development in heart transplant patients. Therefore, when detectable DSA is present in addition to pAMR, a heightened immune regimen (switch to a proliferation signal inhibitor) may be required.
|Endpoints||pAMR Alone (n=53)||DSA Alone (n=53)||pAMR + DSA (n=31)||No pAMR + No DSA (n=263)||P-Value|
|3-Year Freedom from CAV||92.2%||92.5%||71.0%||87.1%||0.043|
|3-Year Freedom from NF-MACE||88.2%||88.7%||87.1%||89.0%||0.999|
CITATION INFORMATION: Patel J., Kittleson M., Kransdorf E., Dimbil S., Levine R., Geft D., Chang D., Czer L., Kobashigawa J. The Combination of pAMR and Circulating Donor-Specific Antibodies is Even More Associated with Cardiac Allograft Vasculopathy after Heart Transplant Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Patel J, Kittleson M, Kransdorf E, Dimbil S, Levine R, Geft D, Chang D, Czer L, Kobashigawa J. The Combination of pAMR and Circulating Donor-Specific Antibodies is Even More Associated with Cardiac Allograft Vasculopathy after Heart Transplant [abstract]. https://atcmeetingabstracts.com/abstract/the-combination-of-pamr-and-circulating-donor-specific-antibodies-is-even-more-associated-with-cardiac-allograft-vasculopathy-after-heart-transplant/. Accessed June 25, 2021.
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