Surveillance donor-specific antibody and pathologic antibody-mediated rejection testing in heart transplant patients in the contemporary era.

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation Pub Date : 2025-02-04 DOI:10.1016/j.healun.2025.01.019

Vincenzo Cusi, Ashley Cardenas, Yuko Tada, Florin Vaida, Nicholas Wettersten, Jennifer Chak, Victor Pretorius, Marcus Anthony Urey, Gerald P Morris, Grace Lin, Paul J Kim

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引用次数: 0

Abstract

Background: Surveillance donor-specific antibody (DSA) and pathologic antibody-mediated rejection (pAMR) testing is recommended in the first year after heart transplantation (HTx) in adult patients. Whether pAMR testing adds prognostic information to contemporary DSA testing has not been fully studied.

Methods: This was a single-center study of consecutive endomyocardial biopsies (EMB) performed between November 2010 and February 2023 in adult HTx patients. The primary objective was to evaluate whether pAMR testing contributes additional information to DSA testing to better predict overall survival. Secondary end-points included cardiac survival and allograft dysfunction.

Results: A total of 6,033 EMBs from 544 HTx patients were reviewed for the study. The pAMR+/DSA+ patients had significantly lower overall (p_c = 0.013) and cardiac survival (p_c = 0.002), while the pAMR+/DSA- and pAMR-/DSA+ patients showed no difference in either outcome compared to the pAMR-/DSA- group. We found significantly lower overall survival in pAMR+/DSA+ patients with allograft dysfunction (p_c < 0.001) but not in pAMR+/DSA+ patients without allograft dysfunction (p_c = 0.569), when compared to the pAMR-/DSA- without allograft dysfunction group. The pAMR+/DSA+ patients with cardiac allograft dysfunction accounted for 18% of deaths or cardiac retransplants while only representing 4% of the HTx cohort. Moderate or severe primary graft dysfunction (PGD) also was a novel risk factor for the development of de novo DSAs (dnDSA) by 4 weeks post-HTx (p = 0.025).

Conclusions: Surveillance DSA testing may effectively identify high-risk pAMR+ patients. Earlier DSA testing at 10 to 14 days post-HTx should also be considered in moderate or severe PGD patients.

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来源期刊

Journal of Heart and Lung Transplantation 医学-呼吸系统

CiteScore

10.10

自引率

6.70%

发文量

1667

审稿时长

69 days

期刊介绍： The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.