title: Prior human leukocyte antigen-allosensitization and left ventricular assist device type affect degree of post-implantation human leukocyte antigen-allosensitization.
abstract: Left ventricular assist device (LVAD) implantation before heart transplantation has been associated with formation of antibodies directed against human leukocyte antigens (HLA), often referred to as sensitization. This study investigated whether prior sensitization or LVAD type affected the degree of post-implantation sensitization. The records of consecutive HeartMate (HM) I and HM II LVAD patients were reviewed. Panel reactive antibody (PRA) was assessed before LVAD implantation and biweekly thereafter. Sensitization was defined as PRA > 10%, and high-degree sensitization was defined as PRA > 90%. An HM LVAD was implanted in 64 patients, and 11 received a HM II LVAD as a bridge to transplant. Ten HM I patients (16%) were sensitized before LVAD implantation (HM I-S), and 54 (84%) were not (HM I-Non-S). Nine HM I-S patients (90%) became highly sensitized (PRA > 90%) compared with 9 HM I-Non-S patients (16.7%; p < 0.001). The PRA remained elevated (> 90%) in 8 of the 9 (88.9%) highly sensitized HM I-S patients vs 5 of the 9 (55.6%) HM I-Non-S highly sensitized patients. The PRA levels in the rest of the HM I-S highly sensitized patients declined from 93% +/- 4% to 55% +/- 15% (p = 0.01). Among the 11 HM II patients, 1 (9%) was sensitized before LVAD implantation (PRA, 40%) and the PRA moderately increased to 80%. No other HM II patient became sensitized after implantation. Thus, 1 of 11 (9%) HM II patients became sensitized compared with 29 of 64 (45%) HM I patients (p = 0.04). Pre-sensitized patients are at higher risk for becoming and remaining highly HLA-allosensitized after LVAD implantation. The HeartMate II LVAD appears to cause less sensitization than HeartMate I.
authors.affiliation: Utah Transplant Affiliated Hospitals (UTAH) Cardiac Transplant Program, Salt Lake City, UT 84112, USA. stavrosdrakos@gmail.com
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Drakos
authors.forename: Abdallah G
authors.initials: AG
authors.lastname: Kfoury
authors.forename: John R
authors.initials: JR
authors.lastname: Kotter
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Reid
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Clayson
authors.forename: Craig H
authors.initials: CH
authors.lastname: Selzman
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Fisher
authors.forename: Mario
authors.initials: M
authors.lastname: Merida
authors.forename: David D
authors.initials: DD
authors.lastname: Eckels
authors.forename: Kim
authors.initials: K
authors.lastname: Brunisholz
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Horne
authors.forename: Sandi
authors.initials: S
authors.lastname: Stoker
authors.forename: Dean Y
authors.initials: DY
authors.lastname: Li
authors.forename: Dale G
authors.initials: DG
authors.lastname: Renlund
mesh_terms: D000328:Adult; D000906:Antibodies / Q000276:immunology; D000917:Antibody Formation; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006333:Heart Failure / Q000276:immunology* / Q000628:therapy; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000906:Antibodies; D006680:HLA Antigens