De Novo Complement-Binding Anti-HLA Antibodies in Heart Transplanted Patients Is Associated with Severe Cardiac Allograft Vasculopathy and Poor Long-Term Survival - Université de Lorraine Access content directly
Journal Articles Journal of Clinical Medicine Year : 2022

De Novo Complement-Binding Anti-HLA Antibodies in Heart Transplanted Patients Is Associated with Severe Cardiac Allograft Vasculopathy and Poor Long-Term Survival

Matteo Pozzi
  • Function : Author
  • PersonId : 1169153
Matthieu Aubry
  • Function : Author
  • PersonId : 1169168
Elisabeth Hugon-Vallet
  • Function : Author
  • PersonId : 1169152
Philippe Portran
  • Function : Author
  • PersonId : 1169170
Jean-François Obadia
  • Function : Author
  • PersonId : 1048326
Olivier Thaunat
  • Function : Author
  • PersonId : 1080996
Laurent Sebbag
  • Function : Author
  • PersonId : 934768

Abstract

Introduction: De novo anti-HLA donor specific antibodies (DSA) have been inconsistently associated with cardiac allograft vasculopathy (CAV) and long-term mortality. We tested whether C3d-binding de novo DSA were associated with CAV or long-term-survival. Methods: We included 282 consecutive patients without preformed DSA on coronary angiography between 2010 and 2012. Angiographies were classified according to CAV ISHLT grading. The primary outcome was a composite criterion of severe CAV or mortality. As the impact of de novo antibodies should be assessed only after appearance, we used a Cox regression with time-dependent covariables. Results: Of the 282 patients, 51(18%) developed de novo DSA during follow-up, 29 patients had DSA with C3d-binding ability (DSA+C3d+), and 22 were without C3d-binding ability (DSA+C3d-). Compared with patients without DSA, DSA+C3d+ patients had an increased risk for the primary outcome of severe CAV or mortality (adjusted HR = 4.31 (2.40–7.74) p < 0.001) and long-term mortality (adjusted HR = 3.48 (1.97–6.15) p < 0.001) whereas DSA+C3d- did not (adjusted HR = 1.04 (0.43–2.47) p = 0.937 for primary outcome and HR = 1.08 (0.45–2.61) p = 0.866 for mortality). Conclusion: According to this large monocentric study in heart transplant patients, donor specific antibodies were associated with worse clinical outcome when binding complement. DSA and their complement-binding ability should thus be screened for to optimize heart transplant patient follow-up.
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hal-03792640 , version 1 (30-09-2022)

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Guillaume Baudry, Matteo Pozzi, Matthieu Aubry, Elisabeth Hugon-Vallet, Raluca Mocan, et al.. De Novo Complement-Binding Anti-HLA Antibodies in Heart Transplanted Patients Is Associated with Severe Cardiac Allograft Vasculopathy and Poor Long-Term Survival. Journal of Clinical Medicine, 2022, 11 (13), pp.3731. ⟨10.3390/jcm11133731⟩. ⟨hal-03792640⟩
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