Novel insights into pretransplant allosensitization in heart transplant recipients in the contemporary era of immunosuppression and rejection surveillance
Language English Country Switzerland Media print-electronic
Document type Comparative Study, Journal Article, Research Support, Non-U.S. Gov't
PubMed
26340387
DOI
10.1111/tri.12684
Knihovny.cz E-resources
- Keywords
- antibody-mediated rejection, heart transplantation, human leukocyte antigens antibodies, prognosis,
- MeSH
- Analysis of Variance MeSH
- Adult MeSH
- HLA Antigens blood immunology MeSH
- Risk Assessment MeSH
- Transplantation, Homologous adverse effects methods MeSH
- Immunization methods MeSH
- Immune Tolerance physiology MeSH
- Immunosuppression Therapy methods MeSH
- Kaplan-Meier Estimate MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Survival Rate MeSH
- Follow-Up Studies MeSH
- Predictive Value of Tests MeSH
- Preoperative Care methods MeSH
- Graft Survival immunology MeSH
- Proportional Hazards Models MeSH
- Graft Rejection immunology MeSH
- Retrospective Studies MeSH
- ROC Curve MeSH
- Chi-Square Distribution MeSH
- Antibody Specificity MeSH
- Histocompatibility Testing MeSH
- Heart Transplantation adverse effects methods mortality MeSH
- Transplantation Immunology physiology MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Comparative Study MeSH
- Names of Substances
- HLA Antigens MeSH
Solid-phase assays (SPA) have facilitated detection and definition of antibodies to human leukocyte antigens (HLA) and major histocompatibility complex class I chain-related antigen A (MICA). However, clinical consequences of pretransplant SPA results in heart transplantation have been studied insufficiently in the current era of immunosuppression and rejection surveillance. Pretransplant sera, panel-reactive antibodies (PRA), pretransplant crossmatch, and clinical data were retrospectively analyzed in 264 adult heart transplant recipients. The specificity of HLA and MICA antibodies and C1q-binding activity of donor-specific antibodies (DSA) were defined using SPA. Pretransplant HLA antibodies were detected in 57 (22%) individuals, in 28 individuals (11%); these antibodies were DSA after transplant. Preformed DSA and elevated peak PRA were independent predictors of pathologic AMR, which occurred in 19 individuals (7%). The increasing number of DSA and the cumulative mean fluorescence intensity of DSA were associated with AMR. C1q-binding assay was a suboptimal predictor of AMR in our cohort. Pretransplant allosensitization and MICA antibodies were related neither to impaired graft survival nor to other adverse clinical events during a median follow-up of 39 months. Identification of preformed DSA by SPA, in addition to PRA monitoring, may predict AMR in the contemporary era of heart transplantation.
Department of Biostatistics Institute for Clinical and Experimental Medicine Prague Czech Republic
Department of Cardiac Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic
Department of Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic
Department of Immunogenetics Institute for Clinical and Experimental Medicine Prague Czech Republic
Department of Pathology Institute for Clinical and Experimental Medicine Prague Czech Republic
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