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Donor-specific HLA-DQ antibodies may contribute to poor graft outcome after heart transplantation

Osama Omrani,a Moheeb Alawwami,b Jehad Buraiki,c Nedim Selimovicd

From the aLondon School of Medicine, Barts and the London School of Medicine and Dentistry, London, United Kingdom; bDepartment of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; cDepartment of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; dDepartment of Cardiology, Angereds Narsjukhus, Angered, Sweden

How to cite this article:

Omrani O, Alawwami M, Buraiki J, Selimovic N. Donor–specific HLA-DQ antibodies may contribute to poor graft outcome after heart transplantation. Ann Saudi Med 2018; 38(2):97-104.


BACKGROUND: HLA-DQ donor-specific antibodies (DSA) are implicated in allograft dysfunction after renal and lung transplantation. Limited data exists on the impact of HLA-DQ antibodies on heart transplant patients.


OBJECTIVE: To investigate the impact of DSA formation on allograft function and outcomes in heart transplant patients.


DESIGN: Retrospective cohort study.


SETTING: Collating post-transplantation patient data from computerized database in a tertiary hospital in Riyadh, Saudi Arabia from January 2006 to October 2014. 


PATIENTS AND METHODS: We excluded recipients with positive preoperative complement-dependent-cytotoxicity crossmatch grafts and those with preformed DSA. Anti-HLA antibodies were identified using Luminex-based assay in sera collected before transplantation with a routine endomyocardial biopsy the first year and then annually. 


MAIN OUTCOME MEASURES: Primary outcome measures were all-cause mortality, development of antibody mediated rejection, treated acute cellular rejection (ACR) and cardiac allograft vasculopathy (CAV).


SAMPLE SIZE: 127 patients.


RESULTS: DSA formation occurred in 43/127 (34%), with 33/43 (77%) targeting HLA-DQ antigens alone (n=7) or in combination with -DR, -A or B antibodies (n=26). Most (76%) were male and the mean (SD) age was 36 (14) years. Ten patients developed -A, -B or -DR antibodies without -DQ antibodies also present. Treated ACR (P=.011), reduced left ventricular ejection fraction (P<.001), CAV development (P=.003), and all-cause mortality (P=.01) were all significantly more prevalent in the DSA-positive cohort.


CONCLUSION: HLA-DQ donor-specific antibodies were the most common type detected and may play a significant role in poor outcomes post-cardiac transplantation. This emphasizes the importance of HLA-DQ matching and monitoring for DSA formation in order to minimize post-transplantation immunological risk. 


LIMITATIONS: Retrospective design comes with inherent biases, results from single institute, with a particularly young cohort.




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