title: Donor-specific anti-HLA antibodies detected by Luminex: predictive for short-term but not long-term survival after heart transplantation.
abstract: In heart transplantation, the clinical significance of pretransplant donor-specific antibodies (DSA) detected by solid phase assay (SPA), which is more sensitive than the conventional complement-dependent cytotoxicity (CDC) assays, is unclear. The aim was to evaluate SPA performed on pretransplant sera for survival after heart transplantation. Pretransplant sera of 272 heart transplant recipients were screened for anti-HLA antibodies using CDC and SPA. For determination of pretransplant DSA, a single-antigen bead assay was performed. The presence of anti-HLA antibodies was correlated with survival. Secondary outcome parameters were acute cellular rejection, graft coronary vasculopathy and ejection fraction. In Kaplan-Meier analysis, SPA-screening did not predict survival (P = 0.494), this in contrast to CDC screening (P = 0.002). However, the presence of pretransplant DSA against HLA class I was associated with decreased short-term survival compared to non-DSA (P = 0.038). ROC curve analysis showed a sensitivity of 76% and specificity of 73% at a cutoff of 2000 MFI. In contrast, the presence of anti-HLA antibodies had no influence on long-term survival, rejection incidence, and graft function. Thus, detection of DSA class I in pretransplant serum is a strong predictor of short-term, but not long-term survival and may help in the early management of heart transplant patients.
authors: Division of Nephrology, University Hospital Zurich, Zurich, Switzerland.
authors: Michelle
authors: M
authors: Raess
authors: Georg
authors: G
authors: Fröhlich
authors: Malgorzata
authors: M
authors: Roos
authors: Barbara
authors: B
authors: Rüsi
authors: Markus J
authors: MJ
authors: Wilhelm
authors: Georg
authors: G
authors: Noll
authors: Frank
authors: F
authors: Ruschitzka
authors: Thomas
authors: T
authors: Fehr
authors: Frank
authors: F
authors: Enseleit
mesh_terms: D006085:Graft Survival / Q000276:immunology; D016027:Heart Transplantation; D015395:Histocompatibility Antigens Class I / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000032:analysis / Q000276:immunology*; D053208:Kaplan-Meier Estimate; D012680:Sensitivity and Specificity; D014019:Tissue Donors; D014181:Transplantation Immunology
chemical_list: D015395:Histocompatibility Antigens Class I; D007518:Isoantibodies
keywords: anti-HLA antibodies; heart transplantation; rejection; survival analysis; vasculopathy