De novo donor HLA specific antibodies after heart transplantation are an independent predictor of poor patient survival

Robinson, D, Banner, N, Goh, A, Hamour, M, Ozawa, M, Rose, M, Smith, J and Terasaki, P (2011) De novo donor HLA specific antibodies after heart transplantation are an independent predictor of poor patient survival. American Journal of Transplantation, 11 (2). pp. 312-319. ISSN 1600-6135

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Abstract

Preformed donor HLA-specific antibodies are a known indicator for poor patient survival after cardiac transplantation. The role of de novo donor-specific antibodies (DSA) formed after cardiac transplantation is less clear. Here we have retrospectively analyzed 243 cardiac transplant recipients, measuring HLA antibody production every year after transplantation up to 13 years post-transplant. Production of de novo DSA was analyzed in patients who had been negative for DSA prior to their transplant. DSA including transient antibodies were associated with poor patient survival (p = 0.0018, HR = 3.198). However, de novo and persistent DSA was strongly associated with poor patient survival (p = 0.0001 HR = 4.351). Although complement fixing persistent DSA correlated with poor patient survival, this was not increased compared to noncomplement fixing persistent DSA. Multivariable analysis indicated de novo persistent DSA to be an independent predictor of poor patient survival along with HLA-DR mismatch and donor age. Only increasing donor age was found to be an independent risk factor for earlier development of CAV. In conclusion, patients who are transplanted in the absence of pre-existing DSA make de novo DSA after transplantation which are associated with poor survival. Early and regular monitoring of post-transplant DSA is required to identify patients at risk of allograft failure.

Item Type: Article
Schools and Departments: School of Mathematical and Physical Sciences > Mathematics
Depositing User: Derek Robinson
Date Deposited: 06 Feb 2012 20:59
Last Modified: 10 Jul 2012 13:09
URI: http://srodev.sussex.ac.uk/id/eprint/28979
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