Crossing Low Level Donor-Specific Antibody at the Time of Heart Transplantation May Save Lives

Abstract

Purpose Sensitization is an increasing problem for patients (pts) awaiting heart transplant (HTx) partly due to increased requirement for bridging with mechanical support, a risk factor for sensitization. In order to widen the donor pool for sensitized pts, our program has decided to cross low-level donor-specific antibody (DSA) at HTx. We assessed the long-term outcome of these pts. Methods Between 2010-13, we reviewed 352 HTx pts in our single-center program and identified 31 pts transplanted against a low-level DSA (MFI Results The 31 pts transplanted against a low-level DSA had significantly less freedom from first-year AMR compared to control group. However, the low-level DSA group had significantly better 5-year survival. There was no significant difference in freedom from 1-year ATR or ACR and 5-year freedom from CAV compared to control group. There was a trend for better 5-year freedom from NF-MACE in the low-level DSA group compared to control group (see table). Conclusion Crossing low-level DSA at HTx appears to have acceptable outcomes despite increased risk of first-year AMR. This strategy can expand the donor pool and potentially save lives. The survival benefit in the low-level DSA group may represent eventual accommodation however further studies are needed.