Occurrence of Fatal and Nonfatal Adverse Outcomes after Heart Transplantation in Patients with Pretransplant Noncytotoxic HLA Antibodies. (29th July 2013)

• Record Type: Journal Article
• Authors: Potena, Luciano; Bontadini, Andrea; Iannelli, Sandra; Fruet, Fiorenza; Leone, Ornella; Barberini, Francesco; Borgese, Laura; Manfredini, Valentina; Masetti, Marco; Magnani, Gaia; Fallani, Francesco; Grigioni, Francesco; Branzi, Angelo
• Other Names: Kaplan Bruce Academic Editor.
• Is Part Of: Journal of transplantation. Volume 2013(2013)
• Publication Date: 2013-07-29
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1155/2013/519680
• Languages: English
• ISSNs: 2090-0007

Abstract

Abstract : HLA antibodies (HLA ab) in transplant candidates have been associated with poor outcome. However, clinical relevance of noncytotoxic antibodies after heart transplant (HT) is controversial. By using a Luminex-based HLA screening, we retested pretransplant sera from HT recipients testing negative for cytotoxic HLA ab and for prospective crossmatch. Out of the 173 consecutive patients assayed (52 ± 13 y ; 16% females; 47% ischemic etiology), 32 (18%) showed pretransplant HLA ab, and 12 (7%) tested positive against both class I and class II HLA. Recipients with any HLA ab had poorer survival than those without (65 ± 9 versus82 ± 3 %;P = 0.02 ), accounting for a doubled independent mortality risk (P = 0.04 ). In addition, HLA-ab detection was associated with increased prevalence of early graft failure (35 versus 15%;P = 0.05 ) and late cellular rejection (29 versus 11%;P = 0.03 ). Of the subgroup of 37 patients suspected for antibody mediated rejection (AMR), the 9 with pretransplant HLA ab were more likely to display pathological AMR grade 2 (P = 0.04 ). By an inexpensive, luminex-based, HLA-screening assay, we were able to detect non-cytotoxic HLA ab predicting fatal and nonfatal adverse outcomes after heart transplant. Allocation strategies and desensitization protocols need to be developed and prospectively tested in these patients.