Donor-specific antibodies to class II antigens are associated with accelerated cardiac allograft vasculopathy: a three-dimensional volumetric intravascular ultrasound study. Transplantation 2013 Jan 27;95(2):389-96
Date
01/18/2013Pubmed ID
23325007Pubmed Central ID
PMC3552316DOI
10.1097/TP.0b013e318273878cScopus ID
2-s2.0-84872926501 (requires institutional sign-in at Scopus site) 67 CitationsAbstract
BACKGROUND: Although a link between donor-specific antibodies against human leukocyte antigens type II (DSA II+) and transplant glomerulopathy has been clearly established, its role in cardiac allograft vasculopathy (CAV) is unclear.
METHODS: Donor-specific antibodies were evaluated using solid-phase single-antigen bead assay before transplantation in 51 heart transplant recipients. Coronary angiography and three-dimensional intravascular ultrasound were performed at baseline and approximately 1 year after the baseline examination.
RESULTS: There were 4 (7.8 %), 11 (21.5%), and 2 (3.9%) patients who had DSA against donor class I (DSA I+), DSA II+, or both, respectively. All patients had negative complement-dependent cytotoxic crossmatch. There was accelerated progression of CAV in the DSA II+ group demonstrated by accelerated progression in plaque index (plaque volume/vessel volume) compared to patients with no DSA II+ antibodies (13.8% [12%] vs. -7.9% [37%], P=0.01). The development of any angiographic CAV was also more common in DSA II+ patients as compared to the DSA- patients at 4 years (100% [0%] vs. 64.2% [10%], P=0.05). All other traditional risk factors for CAV or immunosuppression were similar between the groups (P>0.2 for all).
CONCLUSIONS: This is the first preliminary study demonstrating that heart transplant recipients with preformed class II DSA may be at an increased risk for accelerated CAV as detected by consecutive volumetric three-dimensional intravascular ultrasound.
Author List
Topilsky Y, Gandhi MJ, Hasin T, Voit LL, Raichlin E, Boilson BA, Schirger JA, Edwards BS, Clavell AL, Rodeheffer RJ, Frantz RP, Kushwaha SS, Lerman A, Pereira NLAuthor
Eugenia Raichlin MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Biomarkers
Chi-Square Distribution
Coronary Angiography
Coronary Artery Disease
Female
Heart Transplantation
Histocompatibility
Histocompatibility Antigens Class II
Histocompatibility Testing
Humans
Image Processing, Computer-Assisted
Imaging, Three-Dimensional
Immunosuppressive Agents
Isoantibodies
Kaplan-Meier Estimate
Male
Middle Aged
Plaque, Atherosclerotic
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Ultrasonography, Interventional
Young Adult
