Identification of non-HLA antibodies in ventricular assist device recipients

von Salisch, Sandy, Dieterlen, Maja-Theresa, Garbade, Jens, Klein, Sara, Dhein, Stefan, Mohr, Friedrich W., Bittner, Hartmuth B., Barten, Markus J.

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.

Identification of non-HLA antibodies in ventricular assist device recipients Article