Table 3.
Pre- and Post-transplant IgG DSA Strength and C1q Reactivity in Pediatric (p) and Adult (a) Heart Transplant Recipients: Correlation With AMR, ACR and Response to AMR Treatment
| Pre-transplant
|
Post-transplant
|
||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pts | CXM | DSA | C1q |
1 week
|
2 weeks
|
3 weeks
|
4 to 5 weeks
|
6 weeks
|
|||||||||||||||
| cAMR | ACR | DSA | C1q | cAMR | ACR | DSA | C1q | cAMR | ACR | DSA | C1q | cAMR | ACR | DSA | C1q | cAMR | ACR | DSA | C1q | ||||
| 1p | + | A2 (M) | ND | − | 0R | A2 (M) | − | + | 0R | A2 (M) | − | ||||||||||||
| A23 (M) | ND | A23(M) | − | A23 (M) | + | ||||||||||||||||||
| DR15(M) | − | DR15(M) | − | ||||||||||||||||||||
| DR51(M) | − | DR51(M) | − | ||||||||||||||||||||
| DQ4 (W) | + | ||||||||||||||||||||||
| 2p | + | A2 (M) | + | + | 0R | A2 (M) | + | −p | 0R | A2 (S) | − | ||||||||||||
| B60 (M) | − | ||||||||||||||||||||||
| 3p | + | DR15 (S) | − | + | 0R | DR15 (S) | − | + | 0R | DR15(S) | + | + | 0R | DR15(M) | − | − | 0R | DR15 (S) | − | ||||
| DR7 (M) | − | ||||||||||||||||||||||
| DR51(M) | − | DR51(W) | − | ||||||||||||||||||||
| DQ9 (S) | + | DQ9(S) | + | DQ9(S) | + | DQ9(M) | + | DQ9 (S) | − | ||||||||||||||
| 4p | + | A24 (S) | + | + | 0R | A24 (W) | + | + | 0R | A24 (W) | + | −p | 1R | A24 (M) | − | − | 0R | A24(W) | − | ||||
| B35 (S) | + | B35 (S) | + | B35 (S) | − | B35 (M) | − | ||||||||||||||||
| B64 (S) | − | B64 (S) | − | B64 (S) | − | ||||||||||||||||||
| A33 (M) | − | A33 (S) | − | A33 (M) | − | ||||||||||||||||||
| DR1 (S) | + | DR1 (M) | + | DR1 (M) | + | DR1 (M) | − | ||||||||||||||||
| DQ5 (S) | − | DQ5 (S) | − | DQ5 (S) | + | ||||||||||||||||||
| DQ6 (M) | − | DQ6 (S) | − | DQ6 (S) | + | ||||||||||||||||||
| 5p | − | DQ7 (M) | − | + | 2R | DQ7(S) | + | + | 0R | DQ7(S) | + | ||||||||||||
| A1 (M) | − | A1 (M) | − | ||||||||||||||||||||
| B60(M) | − | B60(M) | − | ||||||||||||||||||||
| DR7(M) | − | DR7(M) | + | ||||||||||||||||||||
| DQ9(M) | − | DQ9(M) | − | ||||||||||||||||||||
| 6p | − | B35 (M) | − | + | B35 (S) | + | + | 0R | B35 (M) | + | −p | 0R | B35 (S) | + | |||||||||
| DR15(M) | − | DR15(S) | − | DR15(W) | − | ||||||||||||||||||
| DR53(M) | − | DR53(S) | + | DR53(S) | + | DR53(S) | − | ||||||||||||||||
| DR4 (W) | − | DR4 (S) | − | DR4 (W) | − | ||||||||||||||||||
| A11 (S) | − | A11 (M) | − | ||||||||||||||||||||
| Cw12(W) | − | ||||||||||||||||||||||
| 7p | − | DQ7 (S) | − | − | 3R | DQ7 (S) | − | − | 3R | DQ7 (S) | − | ||||||||||||
| DR4 (W) | − | DR4 (W) | − | ||||||||||||||||||||
| 8p | − | A24 (W) | − | − | 3R | A24 (W) | − | − | 3R | A24 (W) | − | ||||||||||||
| DR13 (M) | − | ||||||||||||||||||||||
| 9aa | + | A2 (S) | + | − | 0R | A2 (M) | − | − | 0R | A2 (M) | − | ||||||||||||
| A11 (S) | − | A11 (M) | − | A11 (M) | − | ||||||||||||||||||
| Cw12 (S) | − | Cw12 (S) | − | Cw12 (S) | − | ||||||||||||||||||
| 10aa | − | B42 (W) | − | − | 1R | B42 (W) | − | − | 1R | B42 (W) | − | − | 1R | B42 (W) | − | ||||||||
| Cw17(M) | − | ||||||||||||||||||||||
| DR12(W) | − | DR12(W) | − | ||||||||||||||||||||
| DQ5 (W) | − | DQ5 (M) | − | DQ5 (M) | − | DQ5 (M) | − | ||||||||||||||||
| 11a | − | B7 (W) | − | None | B7 (S) | + | + | 0R | B7 (M) | + | + | 1R | B7 (S) | + | −p | 0R | B7 (S) | − | |||||
| DR10(W) | − | DR10(W) | − | DR10(W) | − | DR10(M) | − | ||||||||||||||||
| DR9 (S) | − | DR9 (S) | + | DR9 (M) | − | ||||||||||||||||||
| DQ2 (M) | − | DQ2 (M) | − | DQ2 (M) | − | ||||||||||||||||||
| 12aa | − | DR1 (W) | − | − | 0R | − | 0R | ||||||||||||||||
| 13a | − | DR4 (W) | − | None | DR4 (S) | + | −f | 1R | |||||||||||||||
| DR53(W) | − | DR53(S) | − | ||||||||||||||||||||
| A2 (W) | − | ||||||||||||||||||||||
| A29 (W) | − | ||||||||||||||||||||||
| B62 (M) | − | ||||||||||||||||||||||
ACR, acute cellular rejection; CXM, cytotoxic crossmatch; ND, not done; cAMR, clinical antibody-mediated rejection determined by circulating DSA, pathology and clinical findings (Patients 1p and 3p) and graft dysfunction (Patients 2p, 4p, 5p, 6p and 11a), all treated. S, strong DSA, >8000 MFI; M, moderate DSA, 2,000 to 8,000 MFI; W, weak DSA, 1,000 to 2,000 MFI. None, no biopsy performed at the time of sera analysis (3 to 5 days post-transplant); −p, no cAMR, only pathologic pAMR defined as having diffuse C4d endothelial cell staining ; −f, no cAMR, only focal C4d endothelial staining.
Patients 9a, 10a and 12a were desensitized pre-transplant; Patients 9a and 10a were also treated first week post-transplant with PP/IVIg per protocol when crossing single or multiple S/M DSAs.