Skip to main content
Journal cover image

Pre-Formed Donor-Specific Antibodies Impact Long Term Survival of Heart Transplants

Publication ,  Conference
Song, W; Chen, Q; Patel, C; Yang, Q; Wang, L; Hanshew, WE; DeVore, A; Schroder, J; Milano, C; Rogers, J; Holley, C; Chen, D
Published in: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
April 1, 2020

PURPOSE: We previously reported that heart transplant (HTx) recipients with pre-formed, anti-HLA antibodies at low titer had one-year survival that was comparable to patients without any anti-HLA antibodies. As a result, we defined unacceptable HLA antigens by MFI>1000 in serum at 1:16 dilution. The current study evaluates how pre-formed, low-titer, donor-specific antibodies (DSA) and positive crossmatch affect long term survival of HTx recipients. METHODS: Total 495 adult recipients transplanted at our center between Jan. 2007 and Dec. 2016 were studied. Prior to HTx, recipients had HLA antibody screening (FlowPRA) and specificity testing (LABScreen). Unacceptable HLA antigens were defined by MFI>1000 in serum at 1:16 dilution. Acceptable donors were selected by virtual crossmatch using the criteria above, and flow cytometry crossmatch (FCXM) was performed peri- or post-HTx. Recipients transplanted across low titer DSA, positive in undiluted serum but negative at 1:16 dilution, received peri-operative plasmapheresis. We used log-rank testing to evaluate survival in the following groups compared to their controls: (1) presence of any pre-formed HLA antibodies; (2) presence of pre-formed DSA; and (3) positive FCXM. RESULTS: Of 495 HTx recipients, 179 (36%) had pre-existing HLA antibodies, and their overall survival was not different from patients without HLA antibodies (p=0.883). However, median survival time was reduced in patients with pre-formed DSA (n=62), compared to DSA-negative recipients (n=117): 9.1 years (95% CI 3.52 to 14.65) vs. 10.9 years (95% CI 6.13 to 15.70); p=0.02. The survival rates for 1-, 3-, 5-year of DSA-negative recipients were 91.5%, 85.4% and 79.5%, and the DSA-positive recipients were 83.9%, 66.1% and 61.7%, respectively. Total 62 recipients had pre-HTx DSA. Among them, 26 had a positive FCXM (46%). The survival rates of FCXM-positive cases were lower than FCXM-negative cases (n=36) at 1, 3, and 5 years: 80.8%, 57.9%, 52.1% vs. 86.1%, 71.4%, 67.6%. CONCLUSION: Our findings suggest that pre-formed DSA, even at low titer, negatively impacted HTx survival. Cases with positive FXCM had the worst outcomes. Avoiding all pre-formed DSA may improve survival for HTx patients, but may increase waitlist mortality. To improve the HTx survival, close post-transplant monitoring and proactive immunological management may be required when pre-formed DSA are present.

Duke Scholars

Published In

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

DOI

EISSN

1557-3117

Publication Date

April 1, 2020

Volume

39

Issue

4

Start / End Page

S29

Related Subject Headings

  • Surgery
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Song, W., Chen, Q., Patel, C., Yang, Q., Wang, L., Hanshew, W. E., … Chen, D. (2020). Pre-Formed Donor-Specific Antibodies Impact Long Term Survival of Heart Transplants. In The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (Vol. 39, p. S29). https://doi.org/10.1016/j.healun.2020.01.1173
Song, W., Q. Chen, C. Patel, Q. Yang, L. Wang, W. E. Hanshew, A. DeVore, et al. “Pre-Formed Donor-Specific Antibodies Impact Long Term Survival of Heart Transplants.” In The Journal of Heart and Lung Transplantation : The Official Publication of the International Society for Heart Transplantation, 39:S29, 2020. https://doi.org/10.1016/j.healun.2020.01.1173.
Song W, Chen Q, Patel C, Yang Q, Wang L, Hanshew WE, et al. Pre-Formed Donor-Specific Antibodies Impact Long Term Survival of Heart Transplants. In: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2020. p. S29.
Song, W., et al. “Pre-Formed Donor-Specific Antibodies Impact Long Term Survival of Heart Transplants.” The Journal of Heart and Lung Transplantation : The Official Publication of the International Society for Heart Transplantation, vol. 39, no. 4, 2020, p. S29. Scopus, doi:10.1016/j.healun.2020.01.1173.
Song W, Chen Q, Patel C, Yang Q, Wang L, Hanshew WE, DeVore A, Schroder J, Milano C, Rogers J, Holley C, Chen D. Pre-Formed Donor-Specific Antibodies Impact Long Term Survival of Heart Transplants. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2020. p. S29.
Journal cover image

Published In

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

DOI

EISSN

1557-3117

Publication Date

April 1, 2020

Volume

39

Issue

4

Start / End Page

S29

Related Subject Headings

  • Surgery
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology