Clinical Consequences of Preoperative anti-HLA Antibodies and Panel Reactive Antibodies in Heart Transplantation

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• 作者：T. Gazdic³ ; M. Kubanek¹ ; E. Slimackova² ; A. Slavcev² ; J. Pirk³ ; I. Malek¹
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2013
• 出版时间：April, 2013
• 年：2013
• 卷：32
• 期：4_supp_S
• 页码：S203
• 全文大小：98 K

文摘

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Purpose

Novel solid phase assays provide new insights into pathophysiology of antibody mediated allograft injury in heart transplant (HTx) recipients. We aimed to evaluate clinical consequences of pre-transplant anti-HLA antibodies detected both by Luminex^? and classical cytotoxic test (panel reactive antibodies, PRA).

Methods and Materials

The study group included 185 de-novo HTx recipients [148 males (80 % ), age 50¡À12 years]. They received induction with antithymocyte globulin followed by standard immunosuppression (tacrolimus/cyclosporine + mycophenolate mophetil + prednisone). We analysed pretransplant sera using a solid phase assay Luminex^? and reviewed results of PRA. Occurrence of antibody mediated rejection (AMR), acute cellular rejection (ACR) and all-cause mortality were analysed during a median follow-up of 37 months (20-59).

Results

The peak PRA ¡Ý10 % and PRA ¡Ý 15 % were present in 20 % and 18 % of individuals, respectively. Anti-HLA antibodies class I, class II, MICA antibodies and donor specific antibodies (DSA) were detected in 37 pts (20 % ), 15 pts (8 % ), 25 pts (13 % ) and 23 pts (12 % ), respectively. Clinically significant AMR and ACR were diagnosed in 11 pts (5.9 % ) and 59 pts (32 % ), respectively. The best predictors of AMR were anti-HLA antibodies class I and peak PRA ¡Ý 15 % . Positivity of one of these two variables predicted AMR with a sensitivity of 73 % and specificity of 68 % , p=0.009. Neither PRA nor anti-HLA antibodies were related to ACR or all-cause death. Survival was 93 % and 79 % at 12 months and 5 years, respectively.

Conclusions

Combination of Luminex^? assay and panel reactive antibodies provides reasonable prediction of antibody mediated rejection. Supported by the research grant IGA MZ CR - NT 11262-6.