title: Influence of durable mechanical circulatory support and allosensitization on mortality after heart transplantation.
abstract: Allosensitization has been shown to negatively affect post-heart transplant (HTx) survival even with a negative crossmatch. Whether allosensitization related to mechanical circulatory support (MCS) is associated with worse post-HTx survival remains controversial.
  
  
  
  Adult HTx recipients listed in the United Network for Organ Sharing database (July 2006-December 2012) were identified. Multivariate Cox regression assessed the effect of allosensitization on survival. Propensity matching was performed to compare patients who were and were not allosensitized. Kaplan-Meier survival analysis compared matched and unmatched patients in the MCS and medically managed cohorts.
  
  
  
  We identified 11,840 HTx recipients, of whom 4,167 had MCS. MCS was associated with allosensitization in multivariate logistic regression. Each different MCS device was associated with worse post-HTx survival in multivariate Cox regression. Allosensitization did not predict post-HTx mortality in MCS patients (hazard ratio, 1.07; 95% confidence interval, 0.89-1.28; p = 0.48. Among patients without MCS, allosensitization was associated with post-HTx mortality (hazard ratio, 1.19; 95% confidence interval, 1.03-1.39; p = 0.02). Kaplan-Meier analysis revealed equivalent survival in unmatched and matched cohorts when MCS patients who were allosensitized were compared with non-allosensitized MCS patients. Among non-MCS patients, allosensitization was associated with worse survival in unmatched and matched analysis.
  
  
  
  MCS was associated with allosensitization. For MCS patients, allosensitization did not independently predict worse post-HTx outcome. Among non-MCS patients, allosensitization was associated with worse post-HTx survival. Allosensitization appears to be a heterogeneous process influenced by presence of MCS.
authors: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California.
authors: Peter
authors: P
authors: Chiu
authors: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California.
authors: Justin M
authors: JM
authors: Schaffer
authors: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California.
authors: Philip E
authors: PE
authors: Oyer
authors: Division of Cardiovascular Medicine, Stanford University, School of Medicine, Stanford, California.
authors: Michael
authors: M
authors: Pham
authors: Division of Cardiovascular Medicine, Stanford University, School of Medicine, Stanford, California.
authors: Dipanjan
authors: D
authors: Banerjee
authors: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California.
authors: Y
authors: Y
authors: Joseph Woo
authors: Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California. Electronic address: rha@stanford.edu.
authors: Richard
authors: R
authors: Ha
mesh_terms: D015199:Extracorporeal Membrane Oxygenation; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: heart transplantation; mechanical circulatory support; panel reactive antibody; survival; ventricular assist devices