Complement (C1q) Binding De Novo Donor Specific Antibodies and Cardiac-Allograft Vasculopathy in Pediatric Heart Transplant Recipients.

Background: We hypothesized C1q binding de novo donor specific antibody (DSA) after heart transplant (HT) is a higher risk for development of coronary artery vasculopathy (CAV) in children. Methods: A retrospective analysis of 127 pediatric heart transplant (HT) recipients transplanted between January 2005 and December 2014 was used to determine complement (C1q)-binding de novo DSA on the outcomes of HT and the ability of the C1q assay to predict CAV development. Results: Out of 127 patients, 59 (46.4%) developed de novo DSA, of those 37 had C1q+ DSA. There was no difference in baseline characteristics except patients who developed C1q+ DSA more often received a donor heart from a female compared to C1q- DSA group (p=0.034). The DSA median fluorescent intensity (MFI) value of >=7000 had 80% sensitivity and 80% specificity (C statistics 0.89, p

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