De novo DQ donor-specific antibodies are associated with worse outcomes compared to non-DQ de novo donor-specific antibodies following heart transplantation.
Antibody-mediated rejection (AMR) resulting from de novo donor-specific antibodies (dnDSA) leads to adverse outcomes following heart transplantation (HTx). It remains unclear what role dnDSA to specific HLA antigens play in adverse outcomes. This study compares outcomes in patients developing dnDSA to DQ antigens with those developing non-DQ dnDSA and those free from dnDSA.



The present study was a single-center, retrospective analysis of 122 consecutive HTx recipients. The primary outcome was a composite of death or graft dysfunction.



After 3.3 years of follow-up, 31 (28%) patients developed dnDSA. Mean time to dnDSA was 539 days. Of 31 patients, 19 developed DQ antibodies and 12 developed non-DQ antibodies. Compared to non-DQ dnDSA, DQ antibodies presented with higher MFI values (P=.001) were more likely persistent (P=.001) and appeared later post-HTx (654 vs 359 days, P=.035). In a multivariable analysis, DQ dnDSA was associated with increased risk of the primary endpoint (HR 6.15, 95% CI 2.57-14.75, P=.001), whereas no increased risk was seen with non-DQ dnDSA (P=.749).



dnDSA to DQ antigens following HTx are associated with increased risk of death and graft dysfunction.
Emory University Center for Heart Failure Therapy and Transplantation, Atlanta, GA, USA.
Robert Townsend
0000-0003-0889-9711
RT
Cole
Emory University Department of Medicine, Atlanta, GA, USA.
Jonathan
J
Gandhi
Emory University Department of Pathology and Laboratory Medicine, Atlanta, GA, USA.
Robert A
RA
Bray
Emory University Department of Pathology and Laboratory Medicine, Atlanta, GA, USA.
Howard M
HM
Gebel
Emory University Center for Heart Failure Therapy and Transplantation, Atlanta, GA, USA.
Alanna
A
Morris
Emory University Department of Medicine, Atlanta, GA, USA.
Andrew
A
McCue
Emory University Department of Medicine, Atlanta, GA, USA.
Michael
M
Yin
Emory University Center for Heart Failure Therapy and Transplantation, Atlanta, GA, USA.
S Raja
SR
Laskar
Emory University Center for Heart Failure Therapy and Transplantation, Atlanta, GA, USA.
Wendy
W
Book
Emory University Center for Heart Failure Therapy and Transplantation, Atlanta, GA, USA.
Maan
M
Jokhadar
Emory University Center for Heart Failure Therapy and Transplantation, Atlanta, GA, USA.
Andrew
A
Smith
Emory University Center for Heart Failure Therapy and Transplantation, Atlanta, GA, USA.
Duc
D
Nguyen
Emory University Center for Heart Failure Therapy and Transplantation, Atlanta, GA, USA.
J David
JD
Vega
Emory University Center for Heart Failure Therapy and Transplantation, Atlanta, GA, USA.
Divya
D
Gupta
D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology* / Q000473:pathology; D006085:Graft Survival; D006683:HLA-DQ Antigens / Q000276:immunology*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007518:Isoantibodies / Q000097:blood* / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors
D006683:HLA-DQ Antigens; D007518:Isoantibodies
antibody-mediated rejection; donor-specific antibodies; heart transplantation