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Updated: Oct 19, 2025
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Published on: May 14, 2013
The effects of donor-specific antibody characteristics on cardiac allograft vasculopathy
Maggie Wang1, Nikhil J Patel2, Xiaohai Zhang3
1Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Insights
Certain donor-specific antibodies (DSA) significantly increase the risk of cardiac allograft vasculopathy (CAV) after heart transplants. Persistent, C1q-binding, and Class II DSA are linked to more severe CAV, indicating their prognostic value.
Area of Science:
- Cardiology
- Transplantation Immunology
- Immunology
Background:
- Cardiac allograft vasculopathy (CAV) is a major cause of late graft dysfunction and mortality after heart transplantation.
- The specific impact of different donor-specific antibodies (DSA) on CAV severity remains incompletely understood.
Purpose of the Study:
- To investigate the association between various types of DSA and the incidence of moderate-to-severe CAV (CAV 2/3).
- To identify specific DSA characteristics that may predict CAV development and severity.
Main Methods:
- A cohort of 526 adult heart transplant recipients was analyzed.
- Patients were categorized into DSA-positive (n=142) and DSA-negative (control, n=384) groups.
- DSA subgroups included persistent, transient, 1:8 dilution, C1q-binding, Class I, and Class II DSA.
Main Results:
- Persistent DSA, 1:8 dilution DSA, and C1q-binding DSA were associated with a significantly higher incidence of CAV 2/3 compared to controls (17.6%, 13.3%, and 16.7% vs. 3.1%, respectively).
- Class II DSA also showed a higher incidence of CAV 2/3 (7.6% vs. 3.1%).
- No significant difference in CAV 2/3 incidence was observed between transient DSA and control groups.
Conclusions:
- DSA that are persistent, 1:8 dilution positive, C1q-binding, or Class II are linked to increased risk and severity of CAV.
- These specific DSA profiles may serve as important prognostic markers for CAV.
- Identifying these DSA characteristics could guide therapeutic strategies in heart transplant recipients.
Background:
Cardiac allograft vasculopathy (CAV) causes late graft dysfunction and post-transplant mortality. Currently, the effects of different donor-specific antibodies (DSA) on the severity of CAV remain unclear.
Method:
We evaluated 526 adult heart transplant recipients at a single center between January 2010 and August 2015. Subjects were divided into those with DSA (n = 142) and those without DSA (n = 384, control). The DSA group was stratified into persistent DSA (n = 34), transient DSA (n = 105), 1:8 dilution DSA (n = 45), complement-binding (C1q) DSA (n = 36), Class I DSA (n = 37), and Class II DSA (n = 105). The primary outcome was the incidence of moderate-to-severe CAV (CAV 2/3) at 5-year follow-up.
Results:
Subjects with persistent DSA, 1:8 dilution DSA, and C1q DSA had higher incidence of CAV 2/3 compared the control group (17.6%, 13.3%, and 16.7% vs. 3.1%, respectively; P≤ .001). The incidence of CAV 2/3 between subjects with transient DSA and the control group was similar (2.8% vs. 3.1%; P = .888). Subjects with Class II DSA also had higher incidence of CAV 2/3 (7.6% vs. 3.1%; P = .039).
Conclusion:
DSA that are persistent, 1:8 dilution positive, C1q positive, and Class II are associated with more severe grades of CAV. These DSA characteristics may prognosticate disease and warrant consideration for treatment.
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