Does the Development of Donor Specific Antibody after Heart Transplantation Depend on the Presence or Absence of Corticosteroids as Maintenance Therapy?

Abstract

The development of donor specific antibody (DSA) after heart transplantation has been associated with increased development of cardiac allograft vasculopathy (CAV). Steroid weaning has been popular among heart transplant programs, however, it is not known whether steroid free regimens present an increased risk of the development of DSA. Therefore, we sought to address this question. Between 2010 and 2013 we assessed 229 heart transplantation patients who survived the first year after heart transplantation. Patients were divided into those that were maintained on prednisone (n=120) and those that were weaned off (n=109) at 1-year post-transplant. Subsequent freedom from DSA in the ensuing 5 years was then assessed between these two groups. In addition, we assessed 5-year subsequent outcomes of survival, freedom from CAV, freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), and 1-year freedom from rejection (any treated rejection (ATR), acute cellular rejection (ACR), antibody-mediated rejection (AMR)). There were no significant difference between the two groups in subsequent 5-year freedom from DSA, survival, freedom from NF-MACE, and freedom from rejection. Weaning of corticosteroids from maintenance after heart transplantation does not appear to increase risk for the development of DSA or other clinical longer-term outcomes. The ability to wean corticosteroids in individual patients after transplant may represent an immune-privileged state.