title: De Novo Anti-HLA Antibodies After Heart Transplantation Are Associated With Adverse Events in the Long-term Follow-up of Cardiac Transplant Recipients.
abstract: OBJECTIVE
  Long-term morbidity and mortality after heart transplantation (HTx) remain very high. Several reports have suggested that anti-HLA antibodies (anti-HLA-AB) detected after HTx might be associated with poor survival, but the implication of isolated anti-HLA-AB is still under debate. The aim of the study was to analyze the incidence of de novo anti-HLA-AB and whether they are associated with adverse events after HTx.
  
  
  METHODS
  This retrospective study analyzed the presence of anti-HLA-AB assessed by fluorimetry (Luminex) and quantified by a single-antigen bead assay in 119 HTx patients. Mortality, graft dysfunction, antibody-mediated rejection (AMR), and cardiac allograft vasculopathy (CAV) were recorded. Cardiovascular mortality of patients with and without anti-HLA-AB was compared according Kaplan-Meier curves. Cox regression analyses were performed to identify predictors for global mortality and for a combined endpoint (cardiovascular mortality, AMR, and CAV). Mean age of recipients and donors was 49 ± 15 and 38 ± 14 years, 70% were men, 29% were urgent transplants, and mean ischemic time was 195 ± 56 minutes.
  
  
  RESULTS
  Anti-HLA-AB were detected in 23 patients (19%). These patients had higher rates of AMR (39% vs 1%; P < .05) and cardiovascular mortality (17% vs 2%; P < .05). By multivariate analysis, anti-HLA-AB were the only predictor of the combined endpoint (hazard ratio 3.1; confidence interval 1.3 to 7.5; P = .01). Kaplan-Meier curves showed the worse cardiovascular survival of patients with anti-HLA-AB (72% vs 97%; P = .003).
  
  
  CONCLUSIONS
  Presence of anti-HLA-AB identifies a group of HTx patients with worse prognosis. Better understanding of the immunologic relevance of anti-HLA-AB is expected to improve long-term survival after HTx.
authors.affiliation: Cardiology Department, Hospital de la Santa Creu i Sant Pau, Spain. Electronic address: esoleg@santpau.cat.
authors.forename: E
authors.initials: E
authors.lastname: Solé-González
authors.affiliation: Cardiology Department, Hospital de la Santa Creu i Sant Pau, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Mirabet
authors.affiliation: Cardiology Department, Hospital de la Santa Creu i Sant Pau, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Brossa
authors.affiliation: Cardiology Department, Hospital de la Santa Creu i Sant Pau, Spain.
authors.forename: L
authors.initials: L
authors.lastname: López-López
authors.affiliation: Cardiology Department, Hospital de la Santa Creu i Sant Pau, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Rivas-Lasarte
authors.affiliation: Cardiology Department, Hospital de la Santa Creu i Sant Pau, Spain.
authors.forename: H
authors.initials: H
authors.lastname: Capellades-Olivella
authors.affiliation: Cardiac Surgery Department, Hospital de la Santa Creu i Sant Pau, Spain.
authors.forename: A J
authors.initials: AJ
authors.lastname: Ginel-Iglesias
authors.affiliation: Immunology Department, Hospital Clinic de Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Martorell-Pons
authors.affiliation: Cardiology Department, Hospital de la Santa Creu i Sant Pau, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Roig
mesh_terms: D000328:Adult; D000368:Aged; D000906:Antibodies / Q000276:immunology*; D000961:Antilymphocyte Serum / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000276:immunology; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D000906:Antibodies; D000961:Antilymphocyte Serum; D006680:HLA Antigens