Figure 3. Determination of Human Leukocyte Antibodies Before and After Transplantation.

Pre-transplant sensitizing events include pregnancy, blood transfusions, ventricular assist devices, other mechanical circulatory support, as well as prosthetic materials used during cardiac surgery. As the number of pre-formed human leukocyte antigen (HLA) antibodies increases, the calculated percentage of panel-reactive antibodies (cPRA) increases, decreasing the number of potential donors. After transplantation, preformed antibodies can result in DSA (blue) or the transplant recipient can develop new antibodies, termed de novo DSA (red), both of which are associated with antibody-mediated rejection, cardiac allograft vasculopathy, allograft dysfunction and death.

cPRA, calculated percentage of panel-reactive antibodies; DSA, donor-specific antibody; dnDSA, de novo DSA; LVAD, left ventricular assist device.