Abstract 15693: Future Cardiac Allograft Vasculopathy in Heart Transplant Recipients is Predicted by Class II HLA Eplet Mismatch Score

IntroductionMany heart transplant patients develop a decline in cardiac function over time that is poorly understood. An important association of this is the development of cardiac allograft vasculopathy (CAV), a diffuse arteriopathy which may relate to subclinical chronic rejection. Conventional organ matching has limited sensitivity to predict development of donor-specific antibodies (DSA’s). Using new single-antigen bead technology and matching algorithms, it is now possible to assess compatibility at the fundamental epitope (eplet) level.HypothesisRecipient-donor eplet mismatch at time of transplant predicts development of CAV.MethodsHLA typing was performed on 185 consecutive heart transplants between 2008-16 using Next Generation sequencing (illumina MiSeq, MIA FORA Flex11) and Luminex SSO (One Lamdba Inc.). HLA eplet mismatch was assigned using HLAMatchmaker (v.2.1).ResultsClinical outcomes were available in 177 patients, age 49±13yrs, 64% male, with follow-up 3.5±2.8 years and prevalence of CAV 15%. Sole univariate correlates of CAV were Class II-HLA DQA&B (r=0.2, p=0.009), DR1/3/4/5 (r=0.15, p=0.049) eplet mismatch score and donor age (r=0.29, p