NDLI: The Role of Donor-Specific Antibodies in Acute Cardiac Allograft Dysfunction in the Absence of Cellular Rejection

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The Role of Donor-Specific Antibodies in Acute Cardiac Allograft Dysfunction in the Absence of Cellular Rejection

Content Provider	Scilit
Author	Fine, Nowell M. Daly, Richard C. Shankar, Nisha Park, Soon J. Kushwaha, Sudhir S. Gandhi, Manish J. Pereira, Naveen L.
Copyright Year	2014
Description	Journal: Transplantation Background Acute allograft dysfunction (AAD) is an important cause of morbidity among heart transplant recipients. The role of donor-specific antibodies (DSAs) in AAD, with the increasing use of single antigen bead (SAB) assays that have improved the ability to detect DSA, remains unclear. Methods We retrospectively reviewed 329 heart transplant recipients followed up at our institution. AAD was defined as an acute decline in left ventricular ejection fraction to less than 50% and a decrement of 10% or higher compared to baseline in the absence of cellular rejection. Patients with AAD were compared with matched 30 heart transplant controls. Results There were 10 (3%) patients with AAD, 4 (40%) had DSA detectable by SAB assay compared to 16 (53%) controls (P=0.43). Peak DSA mean fluorescent intensity (MFI) levels were significantly higher at baseline (class I and class II) in AAD compared to controls. DSA MFI values increased at the time of AAD and returned to baseline values during follow-up for these patients with AAD (P<0.05) but remained unchanged over time for controls. Six (60%) patients with AAD and 1 (3%) control had antibody-mediated rejection (AMR) by endomyocardial biopsy (P<0.01). There were 4 (40%) patients with AAD with no DSA or AMR. Conclusions AAD after heart transplant is a heterogeneous process characterized by 1) AMR and DSA, 2) AMR but no DSA, and 3) no AMR or DSA. The presence of DSA is not associated with AAD, but the quantity assessed by MFI levels may play a role.
Related Links	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101052/pdf
Ending Page	238
Page Count	10
Starting Page	229
ISSN	00411337
e-ISSN	15346080
DOI	10.1097/tp.0000000000000047
Journal	Transplantation
Issue Number	2
Volume Number	98
Language	English
Publisher	Ovid Technologies (Wolters Kluwer Health)
Publisher Date	2014-07-27
Access Restriction	Open
Subject Keyword	Journal: Transplantation Peripheral Vascular Disease Allograft Dysfunction Donor-specific Antibodies Antibody-mediated Rejection
Content Type	Text
Resource Type	Article
Subject	Transplantation

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