Document Detail


Donor-specific antibodies to class II antigens are associated with accelerated cardiac allograft vasculopathy: a three-dimensional volumetric intravascular ultrasound study.
MedLine Citation:
PMID:  23325007     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although a link between donor-specific antibodies against human leukocyte antigens type II (DSA II+) and transplant glomerulopathy has been clearly established, its role in cardiac allograft vasculopathy (CAV) is unclear.
METHODS: Donor-specific antibodies were evaluated using solid-phase single-antigen bead assay before transplantation in 51 heart transplant recipients. Coronary angiography and three-dimensional intravascular ultrasound were performed at baseline and approximately 1 year after the baseline examination.
RESULTS: There were 4 (7.8 %), 11 (21.5%), and 2 (3.9%) patients who had DSA against donor class I (DSA I+), DSA II+, or both, respectively. All patients had negative complement-dependent cytotoxic crossmatch. There was accelerated progression of CAV in the DSA II+ group demonstrated by accelerated progression in plaque index (plaque volume/vessel volume) compared to patients with no DSA II+ antibodies (13.8% [12%] vs. -7.9% [37%], P=0.01). The development of any angiographic CAV was also more common in DSA II+ patients as compared to the DSA- patients at 4 years (100% [0%] vs. 64.2% [10%], P=0.05). All other traditional risk factors for CAV or immunosuppression were similar between the groups (P>0.2 for all).
CONCLUSIONS: This is the first preliminary study demonstrating that heart transplant recipients with preformed class II DSA may be at an increased risk for accelerated CAV as detected by consecutive volumetric three-dimensional intravascular ultrasound.
Authors:
Yan Topilsky; Manish J Gandhi; Tal Hasin; Laurie L Voit; Eugenia Raichlin; Barry A Boilson; John A Schirger; Brooks S Edwards; Alfredo L Clavell; Richard J Rodeheffer; Robert P Frantz; Sudhir S Kushwaha; Amir Lerman; Naveen L Pereira
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Transplantation     Volume:  95     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-17     Completed Date:  2013-03-07     Revised Date:  2014-01-28    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  389-96     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Biological Markers / blood
Chi-Square Distribution
Coronary Angiography
Coronary Artery Disease / blood,  immunology*,  radiography,  ultrasonography*
Female
Heart Transplantation / immunology*
Histocompatibility*
Histocompatibility Antigens Class II / immunology*
Histocompatibility Testing
Humans
Image Processing, Computer-Assisted
Imaging, Three-Dimensional*
Immunosuppressive Agents / therapeutic use
Isoantibodies / blood*
Kaplan-Meier Estimate
Male
Middle Aged
Plaque, Atherosclerotic
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Ultrasonography, Interventional*
Young Adult
Grant Support
ID/Acronym/Agency:
HL 84904/HL/NHLBI NIH HHS; KL2 RR024151/RR/NCRR NIH HHS; KL2RR024151/RR/NCRR NIH HHS; UL1RR24150/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Histocompatibility Antigens Class II; 0/Immunosuppressive Agents; 0/Isoantibodies
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