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December 18, 2020Clinical Transplantation

Crossing low/moderate‐level donor‐specific antibodies during heart transplantation

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Why the study?

Pre-transplant DSAs increase rejection risk and prolong waitlist times, but it was unknown whether crossing low/moderate-level DSA at heart transplantation yields acceptable outcomes.

Does crossing low/moderate-level donor-specific antibodies during heart transplantation affect post-transplant outcomes in patients awaiting heart transplantation?

Population

864 patients awaiting heart transplantation between 2010 and 2018

Comparison

Low/moderate-level DSA vs sensitized without DSA vs non-sensitized

Design

Single-center retrospective review

Follow-up

3 years

Authors

GSGayatri SetiaStony Brook University HospitalKNK. NishiharaCedars-Sinai Medical CenterTST. Singer-EnglarCedars-Sinai Medical Center

Discussion

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Implication

Crossing low/moderate DSA was associated with higher early AMR yet similar 3-year outcomes; hypothesis-generating for donor pool expansion in sensitized candidates.

Structured PICO

Does crossing low/moderate-level donor-specific antibodies during heart transplantation affect post-transplant outcomes in patients awaiting heart transplantation?

P
Population
864 patients awaiting heart transplantation between 2010 and 2018, including 67 patients with low/moderate-level donor-specific antibodies (DSA)
I
Intervention
Heart transplantation crossing pre-existing low/moderate-level donor-specific antibodies (DSA)
C
Comparator
Heart transplantation in patients sensitized without DSA, and a control group of non-sensitized patients
O
Outcome
3-year survival, freedom from cardiac allograft vasculopathy (CAV), freedom from non-fatal major adverse cardiac events (NF-MACE), and 1-year freedom from rejectionhard clinical

Crossing low/moderate-level donor-specific antibodies during heart transplantation does not worsen 3-year survival or major adverse cardiac events, potentially expanding the donor pool for sensitized patients despite a higher risk of early antibody-mediated rejection.

Limitations

  • Single-center
  • Retrospective design

Cite This Study

Setia et al. (2020) studied this question.

synapsesocial.com/papers/6a8cf6899cd95633742f076chttps://doi.org/10.1111/ctr.14196

Topics

Heart transplantation
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Also Consider

Synapse has enriched one closely related paper. Consider it for comparative context:

  1. 1De Novo Donor HLA-Specific Antibodies after Heart Transplantation Are an Independent Predictor of Poor Patient Survival2011 · 287 citations