(846) - Sensitized VADs vs. Sensitized Non-VADs: Is There an Immunological Difference?

Abstract

PurposeThe need for ventricular assist devices (VADs) has been increasing over the past several years. Sensitized patients - defined as those with the development of circulating antibodies most likely due to blood transfusions, pregnancy, and previous organ transplants - are known to have poorer outcome after organ transplantation. Patients who undergo VAD implantation may be given blood products and therefore are reported to have a higher incidence of sensitization. It is not known whether these circulating antibodies in a VAD patient have the same immunological impact compared to sensitized non-VAD patients after heart transplant.MethodsBetween 1994 and 2012 we evaluated 160 VAD and 297 non-VAD patients awaiting heart transplant. Specifically, we assessed patients who were sensitized (PRA >10%) to assess their three year post-transplant outcomes [Actuarial survival, freedom from Cardiac Allograft Vasculopathy (CAV) and freedom from Non-Fatal Major Adverse Cardiac Events (NF-MACE, defined as: myocardial infarction, worsening congestive heart failure, percutaneous coronary intervention, ICD/pacemaker insertion, and/or stroke)]. 1 year freedom from cellular (ISHLT grade 2R, 3R) and antibody-mediated rejection (pAMR 1, 2, 3) were also assessed.ResultsThere were 65 sensitized VAD patients compared to 71 sensitized non-VAD patients. Sensitized VAD patients had significantly higher 1 year freedom from antibody-mediated rejection (81.5% vs. 62.0%, p = 0.01) compared to sensitized non-VAD patients (see table). Both Sensitized VAD and sensitized non-VAD patients had comparable 3-year post-transplant outcomes.ConclusionTabled 1Sensitized VAD (n=65)Sensitized Non-VAD (n=71)P-Value1-Year Freedom from Cellular Rejection (ISHLT grade 2R, 3R)81.5%77.5%0.531-year Freedom from Antibody-Mediated Rejection (pAMR 1,2,3)79.0%61.0%0.023-Year Actuarial Survival81.5%84.5%0.623-Year Freedom from CAV92.3%97.2%0.203-year Freedom from NF-MACE93.8%94.4%0.91 Open table in a new tab PurposeThe need for ventricular assist devices (VADs) has been increasing over the past several years. Sensitized patients - defined as those with the development of circulating antibodies most likely due to blood transfusions, pregnancy, and previous organ transplants - are known to have poorer outcome after organ transplantation. Patients who undergo VAD implantation may be given blood products and therefore are reported to have a higher incidence of sensitization. It is not known whether these circulating antibodies in a VAD patient have the same immunological impact compared to sensitized non-VAD patients after heart transplant. The need for ventricular assist devices (VADs) has been increasing over the past several years. Sensitized patients - defined as those with the development of circulating antibodies most likely due to blood transfusions, pregnancy, and previous organ transplants - are known to have poorer outcome after organ transplantation. Patients who undergo VAD implantation may be given blood products and therefore are reported to have a higher incidence of sensitization. It is not known whether these circulating antibodies in a VAD patient have the same immunological impact compared to sensitized non-VAD patients after heart transplant. MethodsBetween 1994 and 2012 we evaluated 160 VAD and 297 non-VAD patients awaiting heart transplant. Specifically, we assessed patients who were sensitized (PRA >10%) to assess their three year post-transplant outcomes [Actuarial survival, freedom from Cardiac Allograft Vasculopathy (CAV) and freedom from Non-Fatal Major Adverse Cardiac Events (NF-MACE, defined as: myocardial infarction, worsening congestive heart failure, percutaneous coronary intervention, ICD/pacemaker insertion, and/or stroke)]. 1 year freedom from cellular (ISHLT grade 2R, 3R) and antibody-mediated rejection (pAMR 1, 2, 3) were also assessed. Between 1994 and 2012 we evaluated 160 VAD and 297 non-VAD patients awaiting heart transplant. Specifically, we assessed patients who were sensitized (PRA >10%) to assess their three year post-transplant outcomes [Actuarial survival, freedom from Cardiac Allograft Vasculopathy (CAV) and freedom from Non-Fatal Major Adverse Cardiac Events (NF-MACE, defined as: myocardial infarction, worsening congestive heart failure, percutaneous coronary intervention, ICD/pacemaker insertion, and/or stroke)]. 1 year freedom from cellular (ISHLT grade 2R, 3R) and antibody-mediated rejection (pAMR 1, 2, 3) were also assessed. ResultsThere were 65 sensitized VAD patients compared to 71 sensitized non-VAD patients. Sensitized VAD patients had significantly higher 1 year freedom from antibody-mediated rejection (81.5% vs. 62.0%, p = 0.01) compared to sensitized non-VAD patients (see table). Both Sensitized VAD and sensitized non-VAD patients had comparable 3-year post-transplant outcomes. There were 65 sensitized VAD patients compared to 71 sensitized non-VAD patients. Sensitized VAD patients had significantly higher 1 year freedom from antibody-mediated rejection (81.5% vs. 62.0%, p = 0.01) compared to sensitized non-VAD patients (see table). Both Sensitized VAD and sensitized non-VAD patients had comparable 3-year post-transplant outcomes. ConclusionTabled 1Sensitized VAD (n=65)Sensitized Non-VAD (n=71)P-Value1-Year Freedom from Cellular Rejection (ISHLT grade 2R, 3R)81.5%77.5%0.531-year Freedom from Antibody-Mediated Rejection (pAMR 1,2,3)79.0%61.0%0.023-Year Actuarial Survival81.5%84.5%0.623-Year Freedom from CAV92.3%97.2%0.203-year Freedom from NF-MACE93.8%94.4%0.91 Open table in a new tab