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The clinical impact of donor-specific antibodies on antibody-mediated rejection and long-term prognosis after heart transplantation

Su, Jennifer A.a,c; Baxter-Lowe, Lee Annb,c; Kantor, Paul F.a,c; Szmuszkovicz, Jacqueline R.a,c; Menteer, JonDavida,c

Current Opinion in Organ Transplantation: June 2019 - Volume 24 - Issue 3 - p 245–251
doi: 10.1097/MOT.0000000000000636
HEART TRANSPLANTATION: Edited by Jon A. Kobashigawa

Purpose of review Outcomes after cardiac transplantation have improved over past decades, but long-term graft survival remains limited in part because of uncertainty regarding clinical implications of donor-specific antibodies (DSAs). The purpose of this review is to consolidate recent advances in knowledge on the topic of DSA and their potential to impact long-term prognosis after heart transplantation.

Recent findings The presence of persistent DSA increases the risk of poor outcome after heart transplantation, including development of antibody-mediated rejection (AMR), graft failure, cardiac allograft vasculopathy, and mortality. Importantly, different DSA vary in clinical significance. DSA capable of activating the complement cascade portend a higher risk of developing AMR. human leukocyte antigen class I and class II antigens are expressed differently within the heart, and so, clinical manifestations of class I and class II DSA vary accordingly. Further, compared with class I, class II DSA carry an increased risk of graft loss and mortality. When comparing preexisting DSA with formation of de-novo DSA, de-novo DSA are associated with worse outcome.

Summary DSAs are generally associated worse long-term prognosis after heart transplantation but vary in their clinical significance. Recognition of specific risk profiles is essential for guiding posttransplant antibody management.

aDivision of Cardiology, Department of Pediatrics

bDepartment of Pathology and Laboratory Medicine, Children's Hospital Los Angeles

cDepartment of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA

Correspondence to Jennifer A. Su, MD, Children's Hospital Los Angeles, 4650 W. Sunset Blvd, Mailstop No. 34, Los Angeles, CA 90027, USA. Tel: +1 323 361 5136; fax: +1 323 361 1513; e-mail:

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