From the Department of Surgery, College of Physicians and Surgeons,
Columbia University, New York, NY.
Correspondence to Silviu Itescu, MD, Columbia-Presbyterian Medical Center, PH14–1485, 622 West 168th St, New York, NY 10032.
Background—Preformed anti-HLA
antibodies reacting specifically with donor lymphocytes have been
associated with acute vascular rejection and early cardiac allograft
failure. However, the effect of preformed anti-HLA antibodies directed
against allogeneic major histocompatibility complex (MHC) class I or II
antigens of a donor panel on heart transplantation outcome has not been
extensively studied.
Methods and Results—The study group consisted of 68 patients who
received cardiac transplants between 1989 and 1996 and who were at high
risk for developing anti-HLA antibodies before transplantation. The
effect of preformed antibodies against allogeneic MHC class I or class
II antigens on the development of early high-grade cellular rejection
and on cumulative annual rejection frequency was determined. Both
patients with left ventricular assist devices and
retransplantation candidates had a similar increase in the frequency of
IgG anti-MHC class II antibodies (IgG anti-II) compared with control
subjects (P<0.0001), whereas the frequency of IgG
anti-MHC class I antibodies (IgG anti-I) was elevated only in patients
with left ventricular assist devices. Pretransplantation
IgG anti-II predicted early development of high-grade cellular
rejection (P=0.006) and higher cumulative annual
rejection frequency (P<0.001) in both of these
sensitized patient groups. Among retransplantation recipients, a match
between donors 1 and 2 at HLA-A additionally predicted an earlier time
to a high-grade cellular rejection.
Conclusions—These results emphasize the importance of
specifically screening heart transplantation candidates for the
presence of IgG antibodies directed against MHC class II molecules and
suggest that strategies aimed at their reduction may have an impact on
the onset and frequency of high-grade cellular rejections after
transplantation.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Preformed IgG Antibodies Against Major Histocompatibility Complex Class II Antigens Are Major Risk Factors for High-grade Cellular Rejection in Recipients of Heart Transplantation
Key Words: transplantation • risk factors • antibodies
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