- Butler, Carrie L;
- Hickey, Michelle J;
- Jiang, Ning;
- Zheng, Ying;
- Gjertson, David;
- Zhang, Qiuheng;
- Rao, Ping;
- Fishbein, Gregory A;
- Cadeiras, Martin;
- Deng, Mario C;
- Banchs, Hector L;
- Torre, Guillermo;
- DeNofrio, David;
- Eisen, Howard J;
- Kobashigawa, Jon;
- Starling, Randall C;
- Kfoury, Abdallah;
- Van Bakel, Adrian;
- Ewald, Gregory;
- Balazs, Ivan;
- Baas, Arnold S;
- Cruz, Daniel;
- Ardehali, Reza;
- Biniwale, Reshma;
- Kwon, Murray;
- Ardehali, Abbas;
- Nsair, Ali;
- Ray, Bryan;
- Reed, Elaine F
We analyzed humoral immune responses to nonhuman leukocyte antigen (HLA) after cardiac transplantation to identify antibodies associated with allograft rejection. Protein microarray identified 366 non-HLA antibodies (>1.5 fold, P < .5) from a discovery cohort of HLA antibody-negative, endothelial cell crossmatch-positive sera obtained from 12 cardiac allograft recipients at the time of biopsy-proven rejection. From these, 19 plasma membrane proteins and 10 autoantigens identified from gene ontology analysis were combined with 48 proteins identified through literature search to generate a multiplex bead array. Longitudinal sera from a multicenter cohort of adult cardiac allograft recipients (samples: n = 477 no rejection; n = 69 rejection) identified 18 non-HLA antibodies associated with rejection (P < .1) including 4 newly identified non-HLA antigenic targets (DEXI, EMCN, LPHN1, and SSB). CART analysis showed 5/18 non-HLA antibodies distinguished rejection vs nonrejection. Antibodies to 4/18 non-HLA antigens synergize with HLA donor-specific antibodies and significantly increase the odds of rejection (P < .1). The non-HLA panel was validated using an independent adult cardiac transplant cohort (n = 21 no rejection; n = 42 rejection, >1R) with an area under the curve of 0.87 (P < .05) with 92.86% sensitivity and 66.67% specificity. We conclude that multiplex bead array assessment of non-HLA antibodies identifies cardiac transplant recipients at risk of rejection.