Impact of Continuous and Pulsatile-Flow Left Ventricular Assist Devices on Post-Transplant Rejection

Abstract

Purpose LVADs have become an established treatment for end stage heart failure patients. The use of mechanical support systems has been associated with overproduction of antibodies with potential donor reactivity. The aim of our study was to assess the impact of different LVAD types on sensitization, post transplantation rejection and survival. Methods and Materials This was a retrospective cohort study of 81 heart transplant recipients who were bridged with either pulsatile (Thoratec PVAD) or continuous-flow (Heart Mate II) devices. Results There were no differences in baseline demographic and clinical characteristics between the groups.[table1]Early mortality was 10.8% in Thoratec PVAD and 2.3% in Heart Mate II group (p = 0.173). Six patients (16.2%) supported with Thoratec PVAD became sensitized versus 17 patients (38.6%) supported with Heart Mate II (p = 0.026). Significantly more patients in Thoratec PVAD group than Heart Mate II group experienced post-transplant rejection.[table2]Survival at 5 years was 59% ± 8% in Thoratec PVAD and 95% ± 3% in Heart Mate II patients. Conclusions Our data suggest that despite higher rates of sensitization in patients supported by Heart Mate II they experience less rejections. Several explanations for the lack of impact of sensitization on post-transplantation rejection have been proposed. Further research is needed into the exact nature, specificities and titers of antibodies associated with continuous-flow LVADs. Table 1 Thoratec PVAD (N = 37) Heart Mate II (N = 44) p Age, years 47 ± 13 48 ± 13 0.688 Male gender 30 (81.1%) 39 (88.6%) 0.340 BSA, m² 1.94 ± 0.2 1.99 ± 0.3 0.327 COPD 6 (16.2%) 6 (13.6%) 0.745 Diabetes Mellitus 9 (24.3%) 9 (20.5%) 0.676 Hypertension 7 (19.9%) 13 (29.5%) 0.239 Non-ischemic etiology of heart failure 20 (54.1%) 22 (50%) 0.7 Donor age, years 32 ± 11 38 ± 11 0.026 Male donor 32 (86.5%) 35 (79.5%) 0.411 Ischemic time, min 151 ± 42 142 ± 62 0.444 Table 2 Thoratec PVAD (N = 37) Heart Mate II (N = 44) p Right heart failure 2 (5.4%) 1 (2.3%) 0.590 Renal failure 4 (10.8%) 5 (11%) NS Rejection 15 (40.5%) 2 (4.5%)