Epitop- Predictions- Algorithmen hinsichtlich der Entwicklung donorspezifischer HLA- Antikörper bei Patienten nach Herztransplantation
Ludwig Passek (München / DE), Carola Grinninger (München / DE), Lisa Kleid (München / DE), Julia Walter (München / DE), Christian Hagl (München / DE), Patrick Möhnle (München / DE), Andreas Humpe (München / DE), Teresa Kauke (München / DE), Andrea Dick (München / DE)
With the steady decline of organ donors, the successful matching of recipients and donors has become increasingly important to insure prolonged survival of the patient. This might also be important for patients awaiting a heart transplant, as it is known that the formation of dnDSA post transplantation has a significant impact on survival and acute cellular rejections. This study aimed to evaluate the effectiveness of epitope-prediction-algorithms regarding the development of dnDSA.
We included 72 heart transplant patients transplanted between 2013 and 2022. None of the patients included in the study showed preformed DSA. HLA-11-loci typing at medium-resolution level were available for recipients and their respective donors. Additionally, all patients had to survive at least 90 days after their surgery so their clinical data could be evaluated. After surgery, blood samples were drawn from the patients in time intervals of 1, 2, 6 and 12 months, and screened for donor specific antibodies (DSA) using the Luminex bead technique. Outcome parameters were the ejection fraction, acute cellular rejection episodes (ACR) up to 1 year after the transplantation, as well as mortality and causes of death. Additionally, to evaluate the cardiac allograft vasculopathy, a standard heart catheterization 1 year after transplantation was used. The ElliPro score (based on the Epitopregister V3.0) and PIRCHE-score were used to evaluate the HLA-discrepancy between recipients and donors.
Only 5/ 72 (6.9%) patients developed dnDSA (n=3 against HLA-class I and n=8 against HLA-class II). There was no correlation between ElliPro/PIRCHE-Score and DSA. But there was a significant correlation between DSA and ACR (p = 0.046/ HR=3,5) as well as between DSA and 1 year mortality (p = 0.01/HR= 69,26).
We are in line with the results of other studies that have already shown that the development of dnDSA is a significant risk factor for ACR and mortality in patients after heart transplantation. Due to the small number of patients who developed de novo DSA no significant correlation could be shown neither between ElliPro- nor PIRCHE-Score and the development of de novo DSA. Higher patient numbers are needed to evaluate Epitop-Prediction-Algorithms.
There are no conflicts of interest.