Novel insights into pretransplant allosensitization in heart transplant recipients in the contemporary era of immunosuppression and rejection surveillance

Eva Svobodova, Tomas Gazdic, Milos Kubanek, Jevgenija Vymetalova, Ludek Voska, Martin Kment, Vera Lanska, Libor Kolesar, Marian Urban, Ivan Netuka, Jan Pirk, Vojtech Melenovsky, Josef Kautzner, Antonij Slavcev, Ivan Malek

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)63-72
Number of pages10
JournalTransplant International
Volume29
Issue number1
DOIs
StatePublished - Jan 1 2016

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Keywords

  • antibody-mediated rejection
  • heart transplantation
  • human leukocyte antigens antibodies
  • prognosis

ASJC Scopus subject areas

  • Transplantation

Cite this

Svobodova, E., Gazdic, T., Kubanek, M., Vymetalova, J., Voska, L., Kment, M., Lanska, V., Kolesar, L., Urban, M., Netuka, I., Pirk, J., Melenovsky, V., Kautzner, J., Slavcev, A., & Malek, I. (2016). Novel insights into pretransplant allosensitization in heart transplant recipients in the contemporary era of immunosuppression and rejection surveillance. Transplant International, 29(1), 63-72. https://doi.org/10.1111/tri.12684