Abstract
Left ventricular assist devices (LVADs) are life-saving bridges to heart transplantation. These LVAD treated patients receive blood transfusion products which can lead to the formation of anti-HLA antibodies and may increase the risk of rejection and graft loss in heart transplanted recipients. Not all transplant centers experience these sensitization problems with LVAD-treated heart allograft recipients. We evaluated our experience with LVAD vs non-LVAD treated heart allograft recipients by correlating HLA allosensitization to rejections and graft survival in transplanted recipients during the first 12 months post transplant. HLA sensitization (PRA > 10%) was determined by an ELISA assay detecting IgG anti-HLA bound to soluble HLA target antigen. Of the 80 LVAD patients, 18% (14/80) were sensitized before LVAD implantation. All LVAD patients received blood product transfusions, however, only an additional 14% (11/80) of the patients became sensitized resulting in a total of 32% sensitized LVAD patients (with a PRA of 23 ± 12%). Of the 80 LVAD patients, 44 received heart allografts within 6 + 5 months following LVAD implantation with 32% of these patients being sensitized (27 + 14% PRA) before transplantation. LVAD-treated heart recipients (whether sensitized before or after LVAD or non-sensitized) all experienced comparable rejection frequencies of approximately 50% and one-year graft survivals of approximately 87%. Non-LVAD heart recipients experienced comparable rejection frequencies and one-year graft survivals whether they were sensitized (3% of the patients with a PRA of 34 ± 26%) or non-sensitized. However, the rejection frequency of 79% for non-LVAD heart recipients was significantly greater than the 47% for LVAD-treated recipients (p<0.001), suggesting that the LVAD process and allosensitization may result in protection. The one-year graft survivals of 83% and 86% were comparable. The data suggest that HLA allosensitization is not a clinical risk factor for LVAD-treated heart recipients.
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