title: Allograft rejection in patients supported with continuous-flow left ventricular assist devices.
abstract: BACKGROUND
  Both pulsatile-flow and continuous-flow left ventricular assist devices (LVADs) successfully provide patients a bridge to transplantation. Some data suggest that continuous-flow pumps increase the risk of allograft rejection, contributing to posttransplantation morbidity and mortality. We sought to analyze the relationship between LVAD flow characteristics and subsequent allograft rejection in bridge to transplant (BTT) patients.
  
  
  METHODS
  Patients with LVADs from the UTAH Transplant Affiliated Hospitals were retrospectively analyzed. Rejection was determined pathologically according to the International Society for Heart and Lung Transplantation revised cardiac allograft rejection scale. Multimodal statistical analyses were applied.
  
  
  RESULTS
  Of 1,076 patients who underwent transplantation over a 26-year period, 151 had LVADs. Of these, 111 (77 pulsatile flow, 34 continuous flow) patients had pathologic data available. There was no difference in overall rejection (grades 1R to 3R) between the pulsatile-flow LVAD and continuous-flow LVAD groups (2.00 ± 1.43 versus 1.50 ± 1.16 episodes/year; p = 0.076.) Patients with pulsatile-flow LVADs had more clinically relevant (grades 2R to 3R) rejection than did patients with continuous-flow LVADs (0.49 ± 0.72 versus 0.12 ± 0.33 episodes/year; p < 0.001). There was no survival difference at 1 year (p = 0.920) or 4 years (p = 0.721) after transplantation.
  
  
  CONCLUSIONS
  Patients with continuous-flow LVADs have similar overall rejection rates and a reduced rate of clinically relevant rejection compared with patients with pulsatile-flow LVADs during the first year after transplantation. Although there is theoretical concern that nonphysiologic, nonpulsatile flow could alter the neurohormonal profile of patients in heart failure, we are encouraged that the type of LVAD circulation does not influence posttransplantation allograft survival.
authors.affiliation: UTAH (Utah Transplant Affiliated Hospitals) Cardiac Transplant Program, University of Utah, Salt Lake City, Utah 84132, USA.
authors.forename: Aaron H
authors.initials: AH
authors.lastname: Healy
authors.forename: Nathan O
authors.initials: NO
authors.lastname: Mason
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Hammond
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Reid
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Clayson
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Drakos
authors.forename: Abdallah G
authors.initials: AG
authors.lastname: Kfoury
authors.forename: Amit N
authors.initials: AN
authors.lastname: Patel
authors.forename: David A
authors.initials: DA
authors.lastname: Bull
authors.forename: Deborah
authors.initials: D
authors.lastname: Budge
authors.forename: Rami A
authors.initials: RA
authors.lastname: Alharethi
authors.forename: Feras M
authors.initials: FM
authors.lastname: Bader
authors.forename: Edward M
authors.initials: EM
authors.lastname: Gilbert
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
authors.forename: Craig H
authors.initials: CH
authors.lastname: Selzman
mesh_terms: D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies