Comparison of De Novo Donor Specific and Nonspecific Antibodies on the Outcome after Heart Transplantation

Objectives: Studies have shown that donor-specific antibodies (DSA) have great impact on the clinical course and overall survival of patients after heart transplantation (HTx). De-novo non-DSA (NSA) were associated with graft loss after kidney transplantation, but it remains unclear to what extent NSA plays a role in rejection, graft function, and overall mortality after HTx. The aim of this study was to analyze and compare the outcome of patients with DSA and NSA after HTx.

Methods: Surveillance endomyocardial biopsies (EMB) were taken after 1, 3, 6, and yearly for 5 years after HTX, and cardiac allograft vasculopathy (CAV) was evaluated via coronary angiography. Serum HLA-class I and II antibodies were collected for analysis of donor specificity twice yearly. The antibody mean fluorescence intensity (MFI) cut-off values were set at >1,000. Study data was collected retrospectively from internal medical records. End points of the study were death of any cause, primary graft failure (PGF), biopsy proven acute cellular rejection (BPACR) ≥2R according to ISHLT, antibody mediated rejection (AMR) and CAV. Complete data was obtained only from patients with a survival of 12 months or greater.

Result: A total of 69 patients with a follow-up time of minutes 18 months to maximum 6 years after HTx were divided into two groups (G1: no DSA or NSA present, n = 41, G2: DSA and/or NSA present, n = 27). G2 was further divided into two subgroups: patients with both DSA + NSA (n = 9) and only NSA (n = 26) status. All-cause mortality was n = 21 (30.9%), with significant difference among the groups (G1: n = 17 (41.5%), G2: n = 4(18.4%)). This trend was also seen among cardiovascular mortality (G1: n = 7 (17.1%), G2: n = 0). No statistically significant difference was seen regarding CAV (G1: n = 3 (7.3%), G2: n = 2 (7.4%)), BPACR (G1: n = 19 (27.9%) or G2: n = 9 (22%)). Surprisingly, AMR was seen in patients in G1 n = 3 (4.4%), but not in G2 (n = 0), but without statistically relevant difference.

Conclusion: Our study shows that DSA and NSA had no negative impact on the outcome up to 6 years after HTx. This might be due to a closer monitoring of the patients after detection of DSA and NSA, and, consequently, an adequate and early adjustment of immunosuppressive therapy including specific DSA treatments to preserve graft function.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021