41 The Effects of Moderate Strength Pre-Transplant Circulating Antibodies on Outcome after Heart Transplantation

Abstract

Purpose: Growing evidence suggests worse cardiac allograft vasculopathy and mortality in heart transplant recipients with asymptomatic antibodymediated rejection (AMR). It is being debated whether therapeutic intervention is warranted to avoid adverse outcomes. In this study we examine the course of individual episodes of untreated asymptomatic AMR on next follow-up endomyocardial biopsy (EMB). Methods and Materials: The UTAH Cardiac Transplant Program database was queried for recipients who survived beyond one year posttransplant and experienced at least one episode of lone AMR with a follow-up EMB. All EMBs were screened for AMR by immunofluorescence and graded for severity (V1, no AMR; V2, borderline; V3, mild; V4, moderate; V5, severe AMR). Asymptomatic AMR was uniformly left untreated. Data were analyzed based on time from transplant (early, 12 months; late, 12 months). Results: 999 heart transplant recipients with a total of 15,448 biopsies between 1985-2009 qualified for the study. Average age at time of transplant was 46.7 years, 13% were female. Outcomes are shown in the table below. Furthermore, after an episode of AMR had resolved, the recurrence rate at 3, 6, and 12 months was 44%, 50.1%, and 56.2% respectively.