Abstract
The methods for detection of post-transplant rejection, especially antibody-mediated rejection (AMR) have been developed for the past three decades and contributed the elucidation of the cardiac allograft vasculopathy (CAV) progression from AMR. However, variation in individual cases is found and it is important to a prediction of the clinical CAV extension to know how various technique is involved on a true clinic. The contribution of alloimmune factors has been increasingly recognized, and thus it is useful to evaluate antibody patterns to prevent CAV. Subjects consisted of 43 patients (10 women; average age at heart transplantation (HTX), 26.1±17.5 years; observation period, 12.1±7.9 years after HTX) who underwent HTX at least 2 years earlier, as well as regular immunological testing, such as panel reactive antibody testing. Clinical data were retrospectively analyzed. (1) Twelve patients showed significant progression of CAV (more than ISHLT CAV2) during follow-up after transplantation, and eight patients demonstrated positive for HLA Class 1 or Class 2 antibodies. Five of these eight patients showed positive donor-specific antibodies and negative for Class 1 C1q antibodies, but four of these five showed positive for Class 2 C1q antibodies. These four patients demonstrated rapid progression of CAV. (2) Four of the 43 patients had a history of C4d-positive antibody-related rejection (AMR), and two of these four patients showed persistent positive Class 2 C1q antibodies. (3) Nine of 12 patients who showed significant progression of CAV demonstrated positive for Class 1 or Class 2 antibodies, or positive for Class 2 C1q antibodies, or had a history of AMR. Alloimmune response is greatly involved in CAV progression, but a difference is found in the extension mechanism in individual cases. Regular immunological evaluations for not only HLA IgG antibodies but also C1q antibodies are useful to better characterize CAV progression.
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