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#64-OR
RELEVANCE OF HLA Ab AND A DONOR SPECIFIC FCXM TO REJECTION AND GRAFT SURVIVAL IN CARDIAC ALLOGRAFT RECIPIENTS.
Ronald Kerman, Ph.D., Branislav Radovancevic, M.D., O.H. Frazier, M.D., Frank Smart, M.D., Noriel Acordia, B.S., Paula Juarez, B.S., L.A. Nemeth, R.N., Barry Kahan, M.D., Ph.D. and Peter Przybylowski, M.D.. Houston TX, USA, University of Texas Medical School-Houston, 77030, Surgery and Houston TX, USA, Texas Heart Institute, 77030, Surgery.

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Cardiac allograft recips are transplanted (Tx) following a (=) IgG AHG XM. Data from renal Tx studies suggested that recips with pre-Tx Flow PRA IgG HLA Ab and a + IgG donor specific FCXM experienced rejection and graft loss. We evaluated the pre-Tx sera of 127 cardiac allograft recips for HLA Abs and a (+) or (=) IgG donor-specific FCXM. Results were correlated to post-Tx rejection and patient survival. Recips with little or no (< 5%) IgG HLA Ab had fewer rejections (10%, 9/86 vs 56%, 23/41, p<0.001) and better graft survival (92%, 65/71 vs 78%, 32/41, p<0.01) than recips with ≥5% (39 ± 19%) IgG HLA Ab. More importantly, those recips with pre-Tx IgG HLA Abs and a (+) IgG donor specific FCXM had 90% (9/10) rejection and only had 70% (7/10) one year graft survival compared with an 11% (7/64) rejection and 92% (59/64) survival for recips with no HLA Ab and a (=) FCXM, p<0.01 for rejection and survival. Recips with no HLA Ab and a (+) IgG FCXM experienced an 8% (1/13) rejection and 92% (12/13) survival. These data suggest that pre-Tx Flow PRA IgG HLA Ab in recip sera correlates with a significant risk for rejection. Recips with both IgG HLA Abs and a (+) IgG donor specific FCXM pre-Tx are at risk for both rejection and graft loss. Having pre-Tx IgG HLA Ab information may influence clinicians to desensitize patients prior to transplantation and/or to choose different immunosuppressive regimens for those sensitized vs nonsensitized recips.