Occurrence of Fatal and Nonfatal Adverse Outcomes after Heart Transplantation in Patients with Pretransplant Noncytotoxic HLA Antibodies
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...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | Journal of Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2013/519680 |
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| author | Luciano Potena Andrea Bontadini Sandra Iannelli Fiorenza Fruet Ornella Leone Francesco Barberini Laura Borgese Valentina Manfredini Marco Masetti Gaia Magnani Francesco Fallani Francesco Grigioni Angelo Branzi |
| author_facet | Luciano Potena Andrea Bontadini Sandra Iannelli Fiorenza Fruet Ornella Leone Francesco Barberini Laura Borgese Valentina Manfredini Marco Masetti Gaia Magnani Francesco Fallani Francesco Grigioni Angelo Branzi |
| author_sort | Luciano Potena |
| collection | DOAJ |
| description | 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±13y; 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. |
| format | Article |
| id | doaj-art-003b0a94a9b6492ebd82299056b6ba6d |
| institution | Kabale University |
| issn | 2090-0007 2090-0015 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Transplantation |
| spelling | doaj-art-003b0a94a9b6492ebd82299056b6ba6d2025-02-03T01:11:27ZengWileyJournal of Transplantation2090-00072090-00152013-01-01201310.1155/2013/519680519680Occurrence of Fatal and Nonfatal Adverse Outcomes after Heart Transplantation in Patients with Pretransplant Noncytotoxic HLA AntibodiesLuciano Potena0Andrea Bontadini1Sandra Iannelli2Fiorenza Fruet3Ornella Leone4Francesco Barberini5Laura Borgese6Valentina Manfredini7Marco Masetti8Gaia Magnani9Francesco Fallani10Francesco Grigioni11Angelo Branzi12Cardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, ItalyImmunogenetics Unit, Transfusion Service, Academic Hospital S. Orsola-Malpighi, University of Bologna, ItalyImmunogenetics Unit, Transfusion Service, Academic Hospital S. Orsola-Malpighi, University of Bologna, ItalyImmunogenetics Unit, Transfusion Service, Academic Hospital S. Orsola-Malpighi, University of Bologna, ItalyPathology Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, ItalyCardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, ItalyCardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, ItalyCardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, ItalyCardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, ItalyCardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, ItalyCardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, ItalyCardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, ItalyCardiovascular Department, Academic Hospital S. Orsola-Malpighi, University of Bologna, Building 21, Via Massarenti 9, 40138 Bologna, ItalyHLA 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±13y; 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.http://dx.doi.org/10.1155/2013/519680 |
| spellingShingle | Luciano Potena Andrea Bontadini Sandra Iannelli Fiorenza Fruet Ornella Leone Francesco Barberini Laura Borgese Valentina Manfredini Marco Masetti Gaia Magnani Francesco Fallani Francesco Grigioni Angelo Branzi Occurrence of Fatal and Nonfatal Adverse Outcomes after Heart Transplantation in Patients with Pretransplant Noncytotoxic HLA Antibodies Journal of Transplantation |
| title | Occurrence of Fatal and Nonfatal Adverse Outcomes after Heart Transplantation in Patients with Pretransplant Noncytotoxic HLA Antibodies |
| title_full | Occurrence of Fatal and Nonfatal Adverse Outcomes after Heart Transplantation in Patients with Pretransplant Noncytotoxic HLA Antibodies |
| title_fullStr | Occurrence of Fatal and Nonfatal Adverse Outcomes after Heart Transplantation in Patients with Pretransplant Noncytotoxic HLA Antibodies |
| title_full_unstemmed | Occurrence of Fatal and Nonfatal Adverse Outcomes after Heart Transplantation in Patients with Pretransplant Noncytotoxic HLA Antibodies |
| title_short | Occurrence of Fatal and Nonfatal Adverse Outcomes after Heart Transplantation in Patients with Pretransplant Noncytotoxic HLA Antibodies |
| title_sort | occurrence of fatal and nonfatal adverse outcomes after heart transplantation in patients with pretransplant noncytotoxic hla antibodies |
| url | http://dx.doi.org/10.1155/2013/519680 |
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