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HLA sensitization is associated with an increased risk of primary graft dysfunction after heart transplantation.
Han, Jiho; Rushakoff, Josh; Moayedi, Yasbanoo; Henricksen, Erik; Lee, Roy; Luikart, Helen; Shalakhti, Omar; Gragert, Loren; Benck, Lillian; Malinoski, Darren; Kobashigawa, Jon; Teuteberg, Jeffrey; Khush, Kiran K; Patel, Jignesh; Kransdorf, Evan.
Affiliation
  • Han J; Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
  • Rushakoff J; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
  • Moayedi Y; Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
  • Henricksen E; Department of Transplant, Stanford Health Care, Stanford, California.
  • Lee R; Department of Transplant, Stanford Health Care, Stanford, California.
  • Luikart H; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California.
  • Shalakhti O; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California.
  • Gragert L; Department of Pathology, Tulane University School of Medicine, New Orleans, Louisiana.
  • Benck L; Division of Cardiology, NorthShore University Health System, Chicago, Illinois.
  • Malinoski D; Critical Care and Acute Care Surgery, Oregon Health Sciences University, Portland, Oregon.
  • Kobashigawa J; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
  • Teuteberg J; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California.
  • Khush KK; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California.
  • Patel J; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
  • Kransdorf E; Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: evan.kransdorf@cshs.org.
J Heart Lung Transplant ; 43(3): 387-393, 2024 Mar.
Article in En | MEDLINE | ID: mdl-37802261
ABSTRACT
Primary graft dysfunction (PGD) is a leading cause of early morbidity and mortality following heart transplantation (HT). We sought to determine the association between pretransplant human leukocyte antigen (HLA) sensitization, as measured using the calculated panel reactive antibody (cPRA) value, and the risk of PGD.

METHODS:

Consecutive adult HT recipients (n = 596) from 1/2015 to 12/2019 at 2 US centers were included. Severity of PGD was based on the 2014 International Society for Heart and Lung Transplantation consensus statement. For each recipient, unacceptable HLA antigens were obtained and locus-specific cPRA (cPRA-LS) and pre-HT donor-specific antibodies (DSA) were assessed.

RESULTS:

Univariable logistic modeling showed that peak cPRA-LS for all loci and HLA-A was associated with increased severity of PGD as an ordinal variable (all loci OR 1.78, 95% CI 1.01-1.14, p = 0.025, HLA-A OR 1.14, 95% CI 1.03-1.26, p = 0.011). Multivariable analysis showed peak cPRA-LS for HLA-A, recipient beta-blocker use, total ischemic time, donor age, prior cardiac surgery, and United Network for Organ Sharing status 1 or 2 were associated with increased severity of PGD. The presence of DSA to HLA-B was associated with trend toward increased risk of mild-to-moderate PGD (OR 2.56, 95% CI 0.99-6.63, p = 0.053), but DSA to other HLA loci was not associated with PGD.

CONCLUSIONS:

Sensitization for all HLA loci, and specifically HLA-A, is associated with an increased severity of PGD. These factors should be included in pre-HT risk stratification to minimize the risk of PGD.
Subject(s)
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Heart Transplantation / Primary Graft Dysfunction Type of study: Etiology_studies / Prognostic_studies / Risk_factors_studies Limits: Adult / Humans Language: En Journal: J Heart Lung Transplant Journal subject: CARDIOLOGIA / TRANSPLANTE Year: 2024 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Heart Transplantation / Primary Graft Dysfunction Type of study: Etiology_studies / Prognostic_studies / Risk_factors_studies Limits: Adult / Humans Language: En Journal: J Heart Lung Transplant Journal subject: CARDIOLOGIA / TRANSPLANTE Year: 2024 Document type: Article