In:
Journal of Transplantation, Hindawi Limited, Vol. 2013 ( 2013), p. 1-6
Abstract:
HLA antibodies (HLA ab) in transplant candidates have been associated with poor outcome. However, clinical relevance of noncytotoxic antibodies after heart transplant (HT) is controversial. By using a Luminex-based HLA screening, we retested pretransplant sera from HT recipients testing negative for cytotoxic HLA ab and for prospective crossmatch. Out of the 173 consecutive patients assayed ( 52 ± 13 y ; 16% females; 47% ischemic etiology), 32 (18%) showed pretransplant HLA ab, and 12 (7%) tested positive against both class I and class II HLA. Recipients with any HLA ab had poorer survival than those without ( 65 ± 9 versus 82 ± 3 %; P = 0.02 ), accounting for a doubled independent mortality risk ( P = 0.04 ). In addition, HLA-ab detection was associated with increased prevalence of early graft failure (35 versus 15%; P = 0.05 ) and late cellular rejection (29 versus 11%; P = 0.03 ). Of the subgroup of 37 patients suspected for antibody mediated rejection (AMR), the 9 with pretransplant HLA ab were more likely to display pathological AMR grade 2 ( P = 0.04 ). By an inexpensive, luminex-based, HLA-screening assay, we were able to detect non-cytotoxic HLA ab predicting fatal and nonfatal adverse outcomes after heart transplant. Allocation strategies and desensitization protocols need to be developed and prospectively tested in these patients.
Type of Medium:
Online Resource
ISSN:
2090-0007
,
2090-0015
Language:
English
Publisher:
Hindawi Limited
Publication Date:
2013
detail.hit.zdb_id:
2503421-2