Abstract
s S305 Purpose: 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. Methods: 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. Results: 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. Conclusion: Compared to sensitized non-VAD patients, sensitized VAD patients appear to have less pAMR after heart transplant, suggesting that their immune response is truncated after removal of the VAD after undergoing heart transplant. Further study into the mechanisms of this observed response is warranted. Sensitized VAD (n= 65) Sensitized Non-VAD (n= 71) P-Value 1-Year Freedom from Cellular Rejection (ISHLT grade 2R, 3R) 81.5% 77.5% 0.53 1-year Freedom from Antibody-Mediated Rejection (pAMR 1,2,3) 79.0% 61.0% 0.02 3-Year Actuarial Survival 81.5% 84.5% 0.62 3-Year Freedom from CAV 92.3% 97.2% 0.20 3-year Freedom from NF-MACE 93.8% 94.4% 0.91
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