Low-dose prophylactic intravenous immunoglobulin does not prevent HLA sensitization in left ventricular assist device recipients.
BACKGROUND
The use of left ventricular assist devices is associated with human leukocyte antigen (HLA) allosensitization. We investigated whether prophylactic treatment with low-dose intravenous immunoglobulin (IVIG), analogous to the use of IgG anti-D (anti-Rh) in preventing Rh immunization, can abrogate HLA allosensitization after left ventricular assist device implantation.


METHODS
We retrospectively reviewed the data from 84 consecutive heart failure patients who underwent implantation of a left ventricular assist device as a bridge to transplantation. After implantation, panel reactive antibody (PRA) was measured biweekly to assess sensitization (defined by PRA > 10%). Patients who were sensitized before left ventricular assist device implantation were excluded from further analysis (n = 12). Patients who either did not require perioperatively transfusions of cellular blood products or received other immunomodifying regimens were also excluded from further analysis (n = 21). The rest of the patients were divided into two groups based on whether they received IVIG, 10 g daily for 3 days (IVIG group, n = 26; non-IVIG group, n = 25). The decision as to whether patients received IVIG was not randomized but was based on surgeon preference.


RESULTS
The sensitization rates (expressed as ratio of sensitized patients to total patients at risk) in the two groups were similar at consecutive time points (2, 4, 6, 8, 12, 20 weeks) after left ventricular assist device implantation. Also, mean PRA at the same time points did not differ between the two groups. Overall, 34.6% (9 of 26) of the IVIG group became sensitized during mechanical support, compared with 32% (8 of 25) of the non-IVIG group (p = 1.0). A PRA of 90% or greater (high-degree sensitization) occurred in 15.3% (4 of 26) of the IVIG group and 12.0% (3 of 25) of the non-IVIG group (p = 0.5).


CONCLUSIONS
The use of low-dose prophylactic IVIG after left ventricular assist device implantation affects neither the incidence nor the severity of HLA allosensitization.
Drakos
Stavros G
SG
LDS Hospital, University of Utah School of Medicine, Utah Transplantation Affiliated Hospitals Cardiac Transplant Program, Salt Lake City, Utah 84143, USA.
Kfoury
Abdallah G
AG
Long
James W
JW
Stringham
James C
JC
Fuller
Thomas C
TC
Nelson
Karl E
KE
Campbell
Beverly K
BK
Gilbert
Edward M
EM
Renlund
Dale G
DG
D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D016027:Heart Transplantation / Q000276:immunology; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D007114:Immunization; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow; D012189:Retrospective Studies; D013499:Surface Properties; D017211:Treatment Failure
D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents