title: Occurrence of Fatal and Nonfatal Adverse Outcomes after Heart Transplantation in Patients with Pretransplant Noncytotoxic HLA Antibodies.
abstract: HLA antibodies (HLA ab) in transplant candidates have been associated with poor outcome. However, clinical relevance of noncytotoxic antibodies after heart transplant (HT) is controversial. By using a Luminex-based HLA screening, we retested pretransplant sera from HT recipients testing negative for cytotoxic HLA ab and for prospective crossmatch. Out of the 173 consecutive patients assayed (52 ± 13y; 16% females; 47% ischemic etiology), 32 (18%) showed pretransplant HLA ab, and 12 (7%) tested positive against both class I and class II HLA. Recipients with any HLA ab had poorer survival than those without (65 ± 9 versus 82 ± 3%; P = 0.02), accounting for a doubled independent mortality risk (P = 0.04). In addition, HLA-ab detection was associated with increased prevalence of early graft failure (35 versus 15%; P = 0.05) and late cellular rejection (29 versus 11%; P = 0.03). Of the subgroup of 37 patients suspected for antibody mediated rejection (AMR), the 9 with pretransplant HLA ab were more likely to display pathological AMR grade 2 (P = 0.04). By an inexpensive, luminex-based, HLA-screening assay, we were able to detect non-cytotoxic HLA ab predicting fatal and nonfatal adverse outcomes after heart transplant. Allocation strategies and desensitization protocols need to be developed and prospectively tested in these patients.
authors: Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, Italy.
authors: Luciano
authors: L
authors: Potena
authors: Andrea
authors: A
authors: Bontadini
authors: Sandra
authors: S
authors: Iannelli
authors: Fiorenza
authors: F
authors: Fruet
authors: Ornella
authors: O
authors: Leone
authors: Francesco
authors: F
authors: Barberini
authors: Laura
authors: L
authors: Borgese
authors: Valentina
authors: V
authors: Manfredini
authors: Marco
authors: M
authors: Masetti
authors: Gaia
authors: G
authors: Magnani
authors: Francesco
authors: F
authors: Fallani
authors: Francesco
authors: F
authors: Grigioni
authors: Angelo
authors: A
authors: Branzi
references: Circulation. 1998 Aug 25;98(8):786-93
references: 9727549
references: J Heart Lung Transplant. 2011 Oct;30(10):1078-94
references: 21962016
references: Clin Transplant. 2012 Jul-Aug;26(4):644-56
references: 22432638
references: J Heart Lung Transplant. 2005 Dec;24(12):2054-9
references: 16364849
references: Hum Immunol. 1998 May;59(5):313-22
references: 9619770
references: Clin Transplant. 2011 Jan-Feb;25(1):E61-7
references: 20973825
references: J Heart Lung Transplant. 1995 Nov-Dec;14(6 Pt 1):1052-6
references: 8719450
references: J Heart Transplant. 1990 Nov-Dec;9(6):587-93
references: 2277293
references: J Heart Lung Transplant. 2009 Nov;28(11):1129-34
references: 19782589
references: J Heart Lung Transplant. 2010 Nov;29(11):1207-9
references: 20810292
references: Hum Immunol. 2009 Oct;70(10):825-9
references: 19555730
references: Am J Transplant. 2013 Apr;13(4):1069-1074
references: 23414257
references: Transplantation. 2000 Oct 15;70(7):1055-9
references: 11045642
references: J Heart Lung Transplant. 2011 Dec;30(12):1305-11
references: 21840734
references: N Engl J Med. 1969 Apr 3;280(14):735-9
references: 4886455
references: Ann Thorac Surg. 2007 Nov;84(5):1556-62; discussion 1562-3
references: 17954062
references: J Heart Lung Transplant. 2011 Mar;30(3):252-69
references: 21300295
references: J Heart Lung Transplant. 2010 Jul;29(7):728-30
references: 20363155
references: J Immunol. 2011 Jan 1;186(1):214-21
references: 21135169
references: J Heart Lung Transplant. 2005 Nov;24(11):1710-20
references: 16297770
references: Hum Immunol. 2009 Aug;70(8):610-7
references: 19375473
references: J Heart Lung Transplant. 2011 Jun;30(6):601-11
references: 21555100