HLA match and other immunological parameters in relation to survival, rejection severity, and accelerated coronary artery disease after heart transplant

The relationship of donor/recipient HLA compatibility to survival, rejection severity and development of coronary arteriopathy after heart transplant is controversial. Furthermore, immunomodulating protocols in these patients have not been based on pretransplant knowledge of HLA match or other immunological parameters. In order to clarify this issue, immunological data from 113 consecutive cardiac transplant patients who were at least 3 months post‐transplant were analyzed in relation to graft/patient survival and severity of rejection episodes. Ninety‐two of these patients either reached the 1‐year post‐transplant follow‐up point and were studied with cardiac catheterization or died with autopsy study of coronary anatomy. These patients were also analyzed for pretransplant immunological factors and post‐transplant development of new lymphocytotoxic antibodies that might predict development of coronary artery disease. Results indicate that better donor/recipient HLA matches, lower pre‐transplant T‐cell panel reactive antibodies (PRA) and negative T‐cell crossmatches are associated with improved graft/patient survival and/or less severe rejection episodes, especially in younger transplant patients. The development of new antilymphocyte antibodies after transplant was associated with the development of new coronary artery disease and with diminished survival. These data, collectively, suggest that patients, especially younger patients, with more poorly matched cardiac transplant donors or pretransplant cytotoxic antibodies should be candidates for more aggressive immunosuppression protocols because of their higher mortality and that all patients should be monitored for the development of new anti‐lymphocyte antibodies.