{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:27:23Z","timestamp":1793831243222,"version":"4.6.1"},"reference-count":114,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2023,12,2]],"date-time":"2023-12-02T00:00:00Z","timestamp":1701475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Antibodies directed against donor-specific human leukocyte antigens (HLAs) can be detected de novo after heart transplantation and play a key role in long-term survival. De novo donor-specific antibodies (dnDSAs) have been associated with cardiac allograft vasculopathy, antibody-mediated rejection, and mortality. Advances in detection methods and international guideline recommendations have encouraged the adoption of screening protocols among heart transplant units. However, there is still a lack of consensus about the correct course of action after dnDSA detection. Treatment is usually started when antibody-mediated rejection is present; however, some dnDSAs appear years before graft failure is detected, and at this point, damage may be irreversible. In particular, class II, anti-HLA-DQ, complement binding, and persistent dnDSAs have been associated with worse outcomes. Growing evidence points towards a more aggressive management of dnDSA. For that purpose, better diagnostic tools are needed in order to identify subclinical graft injury. Cardiac magnetic resonance, strain techniques, or coronary physiology parameters could provide valuable information to identify patients at risk. Treatment of dnDSA usually involves plasmapheresis, intravenous immunoglobulin, immunoadsorption, and ritxumab, but the benefit of these therapies is still controversial. Future efforts should focus on establishing effective treatment protocols in order to improve long-term survival of heart transplant recipients.<\/jats:p>","DOI":"10.3390\/jcm12237474","type":"journal-article","created":{"date-parts":[[2023,12,2]],"date-time":"2023-12-02T13:45:41Z","timestamp":1701524741000},"page":"7474","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["De Novo Donor-Specific Antibodies after Heart Transplantation: A Comprehensive Guide for Clinicians"],"prefix":"10.3390","volume":"12","author":[{"given":"Irene","family":"Marco","sequence":"first","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"L\u00f3pez-Azor Garc\u00eda","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario Puerta de Hierro, 28222 Madrid, Spain"},{"name":"Centro Nacional de Investigaciones Biom\u00e9dicas en Red de Enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain"},{"name":"School of Medicine, Universidad Europea de Madrid, 28670 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Gonz\u00e1lez Mart\u00edn","sequence":"additional","affiliation":[{"name":"Centro Nacional de Investigaciones Biom\u00e9dicas en Red de Enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain"},{"name":"Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Severo S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Dolores","family":"Garc\u00eda-Cos\u00edo Carmena","sequence":"additional","affiliation":[{"name":"Centro Nacional de Investigaciones Biom\u00e9dicas en Red de Enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain"},{"name":"Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1535-9062","authenticated-orcid":false,"given":"Esther","family":"Mancebo Sierra","sequence":"additional","affiliation":[{"name":"Immunology Department, Hospital Universitario 12 de Octubre, Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"de Juan Bagud\u00e1","sequence":"additional","affiliation":[{"name":"Centro Nacional de Investigaciones Biom\u00e9dicas en Red de Enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain"},{"name":"School of Medicine, Universidad Europea de Madrid, 28670 Madrid, Spain"},{"name":"Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Castrodeza Calvo","sequence":"additional","affiliation":[{"name":"Centro Nacional de Investigaciones Biom\u00e9dicas en Red de Enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain"},{"name":"Cardiology Department, Hospital Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Jos\u00e9","family":"Hern\u00e1ndez P\u00e9rez","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario Puerta de Hierro, 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5401-8324","authenticated-orcid":false,"given":"Juan Francisco","family":"Delgado","sequence":"additional","affiliation":[{"name":"Centro Nacional de Investigaciones Biom\u00e9dicas en Red de Enfermedades CardioVasculares (CIBERCV), 28029 Madrid, Spain"},{"name":"Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain"},{"name":"School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/sji.12329","article-title":"Clinical Role of Human Leukocyte Antigen in Health and Disease","volume":"82","author":"Mosaad","year":"2015","journal-title":"Scand. 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