Heart failure & cardiomyopathies
Redefining Cardiac Antibody-Mediated Rejection With Donor-Specific Antibodies and Graft Dysfunction
Authors' conclusion
Expanding the characterization of antibody-mediated rejection to include patients with DSA and concurrent allograft dysfunction identified DSA+ patients at risk for death and prolonged LV dysfunction.
Study context
- Population
- Heart transplant recipientsDSA present in 86 (40%)
- Participants
- 216 recipients
- Exposure
- pAMR+ or DSA+/LV dysfunction vs neither
- Outcome
- Death or sustained (3 months) reduction of LVEF to <50%
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
Death (n=18) or prolonged LV dysfunction (n=10) · long-term
Hazard ratio (95% CI)P value
pAMR+vs Without these outcomes
2.8(1.03–7.4)
P = 0.043DSA+/LV dysfunctionvs Without these outcomes
26.2(9.6–71.3)
P < 0.001Composite of both definitions
6.5(2.9–14.3)
P < 0.001Observational data: associations, not effects.
Further findings
Death within 3 years posttransplant, pAMR+ or DSA+/LV dysfunction within first 6 months
| HR (95% CI) | P value | ||
|---|---|---|---|
| pAMR+ or DSA+/LV dysfunction within 6 months | 3.9 (1.03–14.6) | P = 0.031 | |
| 0.050.21520Hazard ratio (log scale) |
Median
| Outcome | pAMR+ | DSA+/LV dysfunction | Without these outcomes |
|---|---|---|---|
| Median %dd-cfDNA at diagnosis | 0.63% (IQR 0.23–2.0) | 0.40% (IQR 0.36–1.24) | 0.01% (IQR 0.0001–0.10) |
- Median %dd-cfDNA at diagnosis: pAMR+ vs without P=0.0002
- Median %dd-cfDNA at diagnosis: DSA+/LV dysfunction vs without P<0.0001
Rejection episodes
- Isolated pAMR+ episodes
- 14
- Isolated DSA+/LV dysfunction episodes
- 8
- pAMR+ then DSA+/LV dysfunction with pAMR+
- 2
Original publication
Redefining Cardiac Antibody-Mediated Rejection With Donor-Specific Antibodies and Graft Dysfunction. Circ Heart Fail. Published 25 November 2024. doi:10.
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