Early mortality after heart transplantation related to IgA anti–β2-glycoprotein I antibodies

Background The presence of preformed IgA anti-beta-2-glycoprotein-I antibodies (IgA-aB2GP1ab) has been related to early graft loss after kidney transplant. Because beta-2-glycoprotein-I is produced in both the kidney and heart, we have aimed to assess whether the presence of these antibodies may also be associated with poor outcomes after heart transplantation (HT). Methods and results A two-year follow-up retrospective analysis of 151 consecutive patients who underwent HT between 2004 and 2012 was performed to assess the role of this type of preformed antibodies in HT. The population was divided into two groups according to the presence of IgA: Group-1 positive for IgA-aB2GP1ab (47 patients, 31.1%) and Group-2 negative for IgA-Ab2GP1ab (104, 68.9%). Early mortality rates within the first 3 months were higher in group-1 (27.7%) compared to group-2 (9.6%). No differences in donor and recipient characteristics or in causes of death were observed between both groups. Multivariate analysis identified the presence of IgA-aB2GP1ab, female sex and blood typeA as independent risks factors for early mortality after HT. A greater incidence of thrombotic events during the first three months following HT in Group-1 (23.4% versus 5.8%) and a higher presence of risk factors for thrombotic events, which might have exacerbated them, were observed. After this period, no increase in mortality or in thrombotic events was found when both groups were compared. Conclusion Pre-transplant presence of IgA-aB2GP1ab is associated with both increased early mortality rates and higher thrombotic events following HT.