Comparison of HLA & MICA Allosensitization Patterns among Patients Supported by Ventricular Assist Devices (VAD) and Patients with No Devices

Abstract

Purpose Ventricular assist device (VAD) is implicated in HLA-sensitization. We investigate the association between VAD and HLA & MICA sensitization. Methods and Materials Of VAD patients in our institute (00-09); 89 had pre-VAD antibody testing and another in 6 months post-VAD. The comparison group was no-VAD heart transplant candidates; 2 randomly selected/VAD patient matched for year of initial PRA. Results Follow-up was longer in the non-VADs to increase capturing non-VAD increases in PRA (53 vs. 28 days, p=0.001). The number of transfusions was higher in VADs (15 vs. 2), p Table 1 ). In patients with single antigen testing, VAD was associated with new HLA antibody specificities and increased cPRA (16 (0-41)% vs. 0%, p Figure 1 ). Conclusions VAD is associated with HLA sensitization independent of other risk factors. It was not significantly associated with differences in rejection or allograft survival, but may represent a barrier to transplant by limiting donors and lengthening of wait time. Table 1 VAD nonVAD p Class I Pk % 24 (7-72) 6 (2-26) Class I Diff 18 (3-52) 0 (0-1) Class II Pk % 4 (1-16) 2 (1-5) .04 Class II Diff 2 (0-13) 0 .0001