Preformed anti-human leukocyte antigen antibodies jeopardize cardiac transplantation in patients with a left ventricular assist device.
In 1997, 15% of patients who received a cardiac transplant in the United States needed a mechanical circulatory support device before transplantation. One device that patients received was the left ventricular assist device (LVAD). During the LVAD support period, approximately 30% to 80% of LVAD recipients have positive test results for panel reactive antibodies (PRAs). Many of these antibodies form against human leukocyte antigens (HLA). These antigens are present on most cells and stimulate antibody production when a person receives unrelated donor cells. Several pre-LVAD and post-LVAD factors contribute to anti-HLA antibody formation. These antibody levels must be lowered before transplantation because the presence of anti-HLA antibodies makes it more difficult to find a suitable donor and increases the risk of rejection. The objectives of this article are to describe anti-HLA antibody formation in LVAD recipients, review its major consequences and treatments, and discuss nursing actions associated with anti-HLA antibody formation.
Goffinet
Jo
J
University of Wisconsin Hospital and Clinics, Madison, WI 53704, USA.
St Pierre Schneider
Barbara
B
D001323:Autoantibodies / Q000032:analysis*; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000276:immunology* / Q000601:surgery* / Q000628:therapy; D003325:Coronary Care Units; D017809:Fatal Outcome; D006084:Graft Rejection; D006680:HLA Antigens / Q000032:analysis / Q000276:immunology*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D014181:Transplantation Immunology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000628:therapy
D001323:Autoantibodies; D006680:HLA Antigens