Role of HLA matching and donor specific antibody development in long-term survival, acute rejection and cardiac...

Area of Science:

• Immunogenetics
• Transplantation immunology
• Cardiovascular surgery

Background:

• The role of human leukocyte antigen (HLA) matching in heart transplantation remains less defined compared to kidney transplantation.
• Donor-specific antibodies (DSA) can negatively impact heart transplant outcomes, contributing to antibody-mediated rejection (AMR) and cardiac allograft vasculopathy (CAV).

Purpose of the Study:

• To retrospectively analyze the influence of HLA matching and anti-HLA antibodies on overall survival, AMR, and CAV in heart transplant recipients.
• To investigate the association between HLA mismatch, DSA development, and clinical outcomes in heart transplantation.

Main Methods:

• Retrospective analysis of 155 heart transplant patients from 2000-2019.
• Evaluation of HLA mismatch (HLA-A, B, -DR) and presence of anti-HLA antibodies.
• Assessment of associations with overall survival, AMR, and CAV, including analysis of DSA class and mean fluorescence intensity (MFI).

Main Results:

• A negative association was found between HLA-DR mismatch and patient survival (p=0.01).
• No significant difference in CAV development was observed based on HLA class I or class II mismatch.
• DSA were detected in 38.1% of patients; de novo DSA did not influence survival or AMR.
• An association exists between DSA class II and the likelihood of CAV development (p=0.03), with higher MFI in CAV-positive patients.

Conclusions:

• HLA-DR matching appears crucial for heart transplant survival.
• DSA class II is associated with CAV development, highlighting its clinical significance.
• Prospective studies are warranted to evaluate HLA class II matching as a factor in heart allocation, especially given increasing waitlist times.