title: Clinical outcomes in sensitized heart transplant patients bridged with ventricular assist devices.
abstract: BACKGROUND
  Left ventricular assist devices (LVADs) as a bridge to transplant (BTT) have been known to cause allosensitization, as measured by panel-reactive antibody (PRA) levels. The goal of this study was to measure the impact of this allosensitization on outcomes.
  
  
  METHODS
  Panel-reactive antibodies were analyzed in BTT patients, with sensitization defined as peak PRAs ≥ 10%. Baseline characteristics and outcomes in the two patient groups were evaluated using descriptive statistics, Kaplan-Meier, and regression analysis.
  
  
  RESULTS
  Thirty-eight patients were included in the study (17 sensitized vs. 21 non-sensitized). There were more women in the sensitized group (47% vs. 10%, p = 0.023). There was no difference in mean times to high-grade acute cellular rejection (ACR; 18.3 months in sensitized vs. 36.9 months in non-sensitized). Five patients in the sensitized groups developed antibody-mediated rejection (AMR) vs. 0 in the non-sensitized, and all five patients died (Kaplan-Meier log-rank p = 0.024). There was also a significant difference in the incidence of infection at the one- to six-month stage (52.9% vs. 19.0%, p = 0.03).
  
  
  CONCLUSIONS
  Sensitization appears to have a negative effect on mortality. This mortality appears to be concentrated in patients with AMR, and we postulate that the development of AMR in a sensitized patient may be a predictor of mortality.
authors.affiliation: Division of Advanced Heart Failure and Clinical Transplantation, Advocate Christ Medical Center, Oak Lawn, IL, USA.
authors.forename: Sumanth
authors.initials: S
authors.lastname: Kidambi
authors.affiliation: Rush University, Chicago, IL, USA.
authors.forename: Burhan
authors.initials: B
authors.lastname: Mohamedali
authors.affiliation: Division of Advanced Heart Failure and Clinical Transplantation, Advocate Christ Medical Center, Oak Lawn, IL, USA.
authors.forename: Geetha
authors.identifier: http://orcid.org/0000-0002-6500-0437
authors.initials: G
authors.lastname: Bhat
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality; D006680:HLA Antigens / Q000276:immunology*; D016027:Heart Transplantation / Q000401:mortality; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D006680:HLA Antigens; D007518:Isoantibodies
keywords: acute cellular rejection; allosensitization; antibody-mediated rejection; bridge to transplant; heart transplant; infection; left ventricular assist device; mechanical support; mortality; orthotopic heart transplant; outcomes; panel-reactive antibody