Understanding the correlation between DSA, complement activation and antibody mediated rejection in heart transplant recipients

Background Donor specific HLA antibodies (DSA) are associated with increased rates of rejection and of graft failure in cardiac transplantation. The goal of this study was to determine the association of preformed and posttransplant development of newly detected DSA (ndDSA) with antibody mediated rejection (AMR) and characterize the clinical relevance of complement activating DSA in heart allograft recipients. Methods The study included 128 adult and 48 pediatric heart transplant patients transplanted between 2010 to 2013. Routine posttransplant HLA antibody testing was performed by IgG-Single Antigen Bead (SAB) test. The C3d-SAB assay was used to identify complement activating antibodies. Rejection was diagnosed using ISHLT criteria. Results In this study, 22 patients were transplanted with preexisting DSA, and 43 patients developed ndDSA posttransplant. Pretransplant (p

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