Are Those with Primary Graft Dysfunction More Likely to Have Acute Cellular Rejection or Donor-Specific Antibodies after Heart Transplantation?

Purpose Primary graft dysfunction (PGD) is a leading cause of early morbidity and mortality following heart transplantation (HT). We sought to determine the association between PGD and incidence of acute cellular rejection (ACR) and development of de novo donor specific antibodies (DSA) within two years post-HTx. Methods Consecutive adult HT recipients (n=351) from 1/2010 to 7/2018 at a single center were included. Multi-organ and re-transplants were excluded. Definition of moderate and severe PGD was based on the 2014 ISHLT consensus, which includes dependence on extracorporeal membrane oxygenation or intra-aortic balloon pump. The primary outcome was the incidence of ACR (ISHLT grade 2R or 3R) and the development of de novo DSA (mean fluorescence intensity >500) within 2 years post-HTx. Results The cohort was predominantly male (70.6%), with a mean age of 54.1±12.5 years; 34.6% had a durable left ventricular assist device as a bridge to HTx. There were 33 (9.1%) cases of moderate or severe PGD. HLA was assessed in a mean of 15 and 24 samples per patient in those with and without PGD respectively. At two years, patients with PGD had lower incidence of development of de novo DSA against HLA-C (1.6 vs. 3.2%, p=0.047), DP (1.3 vs. 4.3%, p=0.002), DQ (3.3% vs. 11.8%, p Conclusion Development of de novo DSA was lower in the PGD group and there was no difference in overall incidence of ACR in patients with and without PGD at 2 years post-HTx.