Effects of Anti-HLA Antibodies Present before Heart Transplantation on Survival, Acute Cellular Rejection and Coronary Allograft Vasculopathy: A Single Center Experience

Abstract

Purpose Allosensitization prior to heart transplantation has been shown to negatively influence survival, as well as the incidence of immune-response associated complications, namely rejection, coronary allograft vasculopathy and infection. Since increasing numbers of allograft recipients are bridged to transplantation with ventricular assistance devices, this subgroup of recipients is growing. Methods and Materials The data was collected retrospectively and is from 92 cardiac allograft recipients who underwent orthotopic heart transplantation between February 1988 and November 2011 at our center. All patients showing panel reactive antibodies prior to transplantation were included. Allograft vasculopathy was classified by coronary angiography, according to the ISHLT and German Cardiac Society criteria (the latter including peripheral manifestations). ISHLT grading was used for description of rejection episodes. A standard triple immunosuppressive regimen was applied. Results The survival after 30 days and 1-year in the studied group was 78% and 67%, respectively. Most of the mortality was due to allograft failure and rejection (21%). Within the first year 51% of the recipients showed an acute cellular rejection in myocardial biopsy. A Quilty phenomenon was demonstrated in 33%. Allograft vasculopathy was identified in 29% (German Cardiac Society) respectively 8 % (ISHLT) of all cases. Conclusions Pretransplant allosensitization is associated with lower 30-day/1-year survival in the comparison with ISHLT data. The prevalence of immune response associated complications (rejection, allograft vasculopathy) is higher than in recipients without pretransplant anti-HLA antibodies.