Identification of non-HLA antibodies in ventricular assist device recipients

Aims

Recipients of ventricular assist devices (VADR) have a higher incidence to develop antibodies (Abs) against human leukocyte antigens (HLA). Non-HLA antibodies like major histocompatibility complex class I-related chain A (MICA) and autoantibodies against angiotensin type 1 receptor (AT1R) and endothelin receptor A (ETAR) are also implicated in the pathogenesis of acute rejection and allograft vasculopathy. We monitored non-HLA- and HLA-Abs in VADR up to one year after implantation.

Materials and methods

Sera of 56 VADR (54.1±12.8 years old, 50 men) were analyzed for Abs against HLA-, MICA-, AT1R- and ETAR several times over one year after implantation using ELISA and Luminex xMAP technology. Blood transfusions, gender and age were reviewed.

Results

Half of the VADR were positive (>16.5 U/l) for Abs against AT1R (50%) and ETAR (51.8%) with high titres up to 1000 U (21.4% each) or above 2000 U (anti-AT1R: 19.6%; ETAR: 25%). 58.9% of the VADR showed moderate titres of HLA- and/or MICA-Abs within the first year (HLA-class I-Abs: 44.6%, HLA-class II-Abs: 25%, MICA-Abs: 25%). Of note, AT1R- and ETAR-Ab positive VADR received more blood transfusions, with statistical significance in platelet transfusions (1.9±2.5 vs. 4.4±6).

Conclusion

Beside HLA- and MICA-Abs, VADR showed high titres of Abs against AT1R or ETAR, which underlines the necessity for monitoring non-HLA antibodies in VADR prior heart transplantation.

Imprint

Sandy von Salisch, Maja-Theresa Dieterlen, Jens Garbade, Sara Klein, Stefan Dhein, Friedrich W. Mohr, Hartmuth B. Bittner, Markus J. Barten. Identification of non-HLA antibodies in ventricular assist device recipients; Cardiometry; No.3; November 2013; p.82-99; DOI:10.12710/cardiometry.2013.3.8299 Available from: www.cardiometry.net/no3-november-2013/identification-of-non-hla-antibodies