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THE PRESENCE OF HLA ANTIBODIES POST HEART TRANSPLANT IS ASSOCIATED WITH POOR ALLOGRAFT OURCOME.
Anat R. Tambur, DMD PhD , Salpy Pamboukian MD , Nancy D. Herrera , Eti Shabtai MS and Alain Heroux MD . Chicago IL, Rush Medical Center, 60612, Heart Failure and Cardiac Transplant Program and Tel Aviv Israel, Ichilov Medical Center, Statistics .
BACKGROUND: The clinical significance of HLA antibodies following heart transplantation (HT) is an area of on-going debate.
METHODS: Seventy-one HT recipients with a minimum of 6 months follow-up (mean 28M) were enrolled in this study after consenting. Demographics - age 47±19 yrs, 86% male, 35% AA, ischemia time 177±51 mins. Fifty four% received L-VAD as a bridge for transplantation. Serum specimens were collected at fixed intervals post transplant [2,4 weeks; 2,3,6 and 12 month and at annual visits thereafter – mean of 6.9 serum specimens/patient]. PRA analysis was performed using Flow-PRA screening for class I and class II antigens individually. Allograft biopsies were evaluated using ISHLT score criteria.
RESULTS: 22 recipients had detectable HLA antibodies during the first year post HT (19 had class I antibodies – PRA mean of 10.5%, and 10 class II antibodies – mean 20.6%). Mean HLA mismatch was 1.48, 1.66, and 1.48 for HLA-A, -B, and –DR loci, respectively. Interestingly, the majority of class II antibodies were directed against HLA-DQ antigens. The presence of HLA antibodies post HT was correlated with transplantation outcome using uni-and multi-variant analysis. Death, that was recorded for 21/71 patients during the study follow-up time, was found to be associated more with the presence of class I ANTIBODIES (p=0.01), as did humoral rejection burden (p=0.019). Conversely, cellular rejection burden was correlated with the presence of class II antibodies (p=0.0089).
CONCLUSIONS: There is a significant correlation between the presence of HLA antibodies post HT and cardiac transplant outcome. Monitoring for these antibodies, using solid phase techniques, can identify patients at risk to develop cellular and humoral damage to the allograft.