BACKGROUND The presence of antibodies to donor-specific HLAs is a well-known risk factor associated with heart transplantation (HTx) outcomes. Recently, non-HLA antibodies were reported to be associated with HTx outcomes.

METHODS We evaluated the association between the presence of non-HLA antibodies with early (≤1 y) and long-term graft failure in 192 patients undergoing HTx in 4 large transplant centers in Korea.

RESULTS Antibodies to vimentin (AVA) and type II collagen (ACA) were associated with a lower rate of 1-y graft survival (78.6% versus 92.6%, log-rank P = 0.006 for AVA + ; 72.2% versus 91.1%, log-rank P = 0.015 for ACA + ). AVA + stratified 1-y graft survival in patients with donor-specific antibodies (DSAs + ; 45.5% versus 94.1%, log-rank P = 0.002). AVA + also improved the prediction models based on conventional risk factors derived from Cox regression analysis (integrated discrimination improvement, 9%; P < 0.001; net reclassification index, 24%; P = 0.047). Compared with AVA - /ACA - patients, AVA + /ACA + patients had poor graft survival both in the early and late periods (all log-rank P < 0.001).

CONCLUSIONS In conclusion, the presence of non-HLA antibodies to vimentin and type II collagen was associated with poor graft outcomes in patients undergoing HTx. These findings highlight the need to consider non-HLA antibodies in assessing transplant recipients and tailoring immune modulation strategies.