Abstract
In 2010, at ASHI, we presented our preliminary data of using antibody titration to determine unacceptable HLA antigens (UAG) for selection of deceased donors for heart transplant. The one-year survival rate of recipients who had “low titer” donor-specific antibody (DSA) was comparable to recipients who had no DSA or no pre-transplant sensitization. This approach has been continuously used at our transplant center. This study was conducted to evaluate the survival of recipients who received a heart transplant between 2010 and 2013 and to assess the risk of “low titer” DSA in the current cohort. All patients that received heart transplants from January 1, 2010 and December 31, 2013 were included in this study. Prior to listing, all patients were evaluated for HLA sensitization which was defined by presence of any HLA antibodies detected by Flow antibody screening and Luminex single antigen bead assay. For sensitized recipients, a titration test at 1:16 dilution was performed. Utilizing the principle of virtual crossmatch (VXM), only donors without UAGs determined at 1:16 dilution were selected for sensitized patients. All final XMs were performed by flow cytometry. A total of 183 recipients were included in this current study. Among them, 84 (45.9%) were pre-transplant sensitized. Among the 84 sensitized patients, 28 patients received organs with UAGs as determined by Abs detected in undiluted serum samples. 13 of these 28 patients had positive HLA XM by flow cytometry. The one-year survival rate of the 56 sensitized patients who received organs without UAGs and the 28 sensitized patients who received organs with UAGs were equal, that is 89.3%. The one-year survival of the 99 non-sensitized patient is 92.9% (p = 0.685, comparing to that of sensitized patients). Among the 28 pts who received organs with UAGs determined in undiluted serum samples, the 1 year survival rate of patients with a positive XM (N = 13) is 84.6%, while the 1 year survival rate for the patients (N = 15) with a negative XM is 93.3% (p = 0.58). Based on our data, we conclude that the current approach of using a 1:16 titration to determine UAGs for the transplantation of sensitized heart patients is an acceptable practice. The long term survival beyond 1 year warrants further investigation.
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