Purpose: The development of anti-HLA antibodies following heart transplantation has been associated with poor outcomes, including lower survival and increased risk for the development of cardiac allograft vasculopathy (CAV). It is known that anti-HLA antibodies may develop more than a year after heart transplantation but it is not known whether these antibodies have clinical relevance.

Methods: Between 2009 and 2013, we reviewed 71 heart transplant patients were found to have donor specific antibodies (DSA) early versus late after heart transplant. Late antibodies were defined as antibodies that developed after 1 year post-transplant. Subsequent 1 year survival, freedom from cardiac allograft vasculopathy (CAV), and freedom from rejection were then assessed.

Results: Those patients who developed late DSA (at a mean time of 29.2 ± 10.3 months post-transplant) have a lower freedom from biopsy negative rejection in the ensuing year after detection of the initial antibody compared to those patients who developed early DSAs (at a mean time of 1.7 ± 3.3 months post-transplant). However, patients who developed late DSA did not appear to have worse outcomes in terms of 1-year subsequent actuarial survival, freedom from CAV, any-treated rejection, treated cellular rejection and treated antibody-mediated rejection compared to those who developed early DSA (see table).

Conclusion: Late DSA development may be a marker for the development of biopsy negative rejection. However, subsequent survival and development of CAV, treated cellular rejection, and treated antibody mediated rejection do not appear to be affected. Longer follow-up with larger numbers will be needed to confirm these results.

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