RT Journal Article
T1 De Novo Donor-Specific Antibodies after Heart Transplantation: A Comprehensive Guide for Clinicians
A1 Marco, Irene
A1 López Azor García, Juan Carlos
A1 González Martín, Javier
A1 Severo Sánchez, Andrea
A1 García Cosío Carmena, María Dolores
A1 Mancebo Sierra, María Esther
A1 De Juan Bagudá, Javier
A1 Castrodeza Calvo, Javier
A1 Hernández Pérez, Francisco José
A1 Delgado Jiménez, Juan Francisco
AB Antibodies directed against donor-specific human leukocyte antigens (HLAs) can be detected de novo after heart transplantation and play a key role in long-term survival. De novo donor-specific antibodies (dnDSAs) have been associated with cardiac allograft vasculopathy, antibody-mediated rejection, and mortality. Advances in detection methods and international guideline recommendations have encouraged the adoption of screening protocols among heart transplant units. However, there is still a lack of consensus about the correct course of action after dnDSA detection. Treatment is usually started when antibody-mediated rejection is present; however, some dnDSAs appear years before graft failure is detected, and at this point, damage may be irreversible. In particular, class II, anti-HLA-DQ, complement binding, and persistent dnDSAs have been associated with worse outcomes. Growing evidence points towards a more aggressive management of dnDSA. For that purpose, better diagnostic tools are needed in order to identify subclinical graft injury. Cardiac magnetic resonance, strain techniques, or coronary physiology parameters could provide valuable information to identify patients at risk. Treatment of dnDSA usually involves plasmapheresis, intravenous immunoglobulin, immunoadsorption, and ritxumab, but the benefit of these therapies is still controversial. Future efforts should focus on establishing effective treatment protocols in order to improve long-term survival of heart transplant recipients.
PB MDPI
SN 2077-0383
YR 2023
FD 2023
LK https://hdl.handle.net/20.500.14352/103490
UL https://hdl.handle.net/20.500.14352/103490
LA eng
NO Marco, I.; López-Azor García, J.C.; González Martín, J.; Severo Sánchez, A.; García-Cosío Carmena, M.D.; Mancebo Sierra, E.; de Juan Bagudá, J.; Castrodeza Calvo, J.; Hernández Pérez, F.J.; Delgado, J.F. De Novo Donor-Specific Antibodies after Heart Transplantation: A Comprehensive Guide for Clinicians. J. Clin. Med. 2023, 12, 7474. https:// doi.org/10.3390/jcm12237474
DS Docta Complutense
RD 30 abr 2025