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.
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