Background and Aims

Circulating immunecom­plexes between IgA anti Beta2-glycoprotein (aB2GP1) antibodies and B2GP1 (B2A-CIC) have been associated with acute thrombotic events in patients positive for IgA aB2GP1. In renal transplantation, B2A-CIC associates early graft loss. Interestingly, patients negative for B2A-CIC and positive por IgA aBGP1 have the same risk than those without antiphospholipid antibodies. The aim of this study is to determine the role of B2A-CIC after heart trasplantation.

Methods

151 consecutive patients who received a heart transplant were followed-up for 2 years. IgA aB2GP1 and B2A-CIC were quantified in pretransplant serum samples. Patients were divided into 3 groups: Group-1, positive for IgA aB2GP1 and B2A-CIC (N=19). Group-2, only positive for IgA aB2GP1 (N=28). Group-0 (control group): IgA aB2GP1 negative (N=104).

Results

Mortality in Group-1 was higher than group-0 at 3 months (HR:5.08; 95%CI: 1.36-19.01). There were no significant differences between group-2 and group-0. Multivariate analysis identified B2A-CIC as the most important independent risk factor for early mortality (OR=6.12; 95% CI:1.93-19.4).

Post-transplant incidence of thrombosis was higher in Group-1 than control group (OR:6.42; 95%CI: 2.1-19.63). Multivariate analysis identified B2A-CIC (OR:6.13; 95%CI:2.1-19.63) and pretrasplant active smoking as independent risk factor for thrombosis.

The proportion of patients who had thrombotic events or died in the first trimester was significantly higher in group-1 (73.7%) than in group-0 (16.3%; p<0.001) and in group-2 (39.3%; p=0.02). Multivariate analysis identified B2A-CIC as the main independent risk factor for early outcomes (mortality or thrombosis) in the first three months after heart transplant (OR=11.42, 95% CI: 1.69-9.68).

Conclusions

B2A-CIC predict early mortality and thrombosis after heart transplant