title: The impact of Angiotensin II Type 1 Receptor antibodies on morbidity and mortality in Heart Mate II supported recipients.
abstract: OBJECTIVE
  One of the proposed limitations of left ventricular assist device (LVAD) therapy is high degree of sensitization. Apart from human leukocyte antigen (HLA), antibodies against Angiotensin II Type 1 Receptor (AT1R) have been associated with adverse outcomes. The purpose of this study was to compare complications and survival of anti - AT1R positive versus negative Heart Mate II (HMII) recipients.
  
  
  METHODS
  Altogether 96 patients received HMII at our institution between 2008 and 2012. These were stratified into three groups: antibody positive before implantation (AT1R+), antibody conversion during support (AT1R-/+) and patients who remained antibody negative (AT1R-). Survival, major on-device adverse events and post-transplant rejections were assessed with Kaplan-Meier and log-rank tests.
  
  
  RESULTS
  Two year on-device and overall survival was 78 ± 12% and 75 ± 10% in AT1R-, 60 ± 23% and 60 ± 15% in AT1R+ and 92 ± 6% and 87 ± 5% in AT1R-/+ group (P = 0.409, P = 0.185). Freedom from major adverse event at two years for AT1R-, AT1R+ and AT1R-/+ was 49 ± 14%, 53 ± 16% and 41 ± 11% (P = 0.875). Freedom from rejection was 63 ± 17% in patients who were both anti-AT1R and HLA negative and 65 ± 13% in those who were antibody positive (P = 0.788).
  
  
  CONCLUSIONS
  Patients who were anti-AT1R antibody positive had similar on-device survival and rate of complications in comparison to those who were antibody negative. In transplanted patients, there were no differences in the overall survival and rejection between the groups.
authors.affiliation: Department of Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Urban
authors.initials: U
authors.lastname: Marian
authors.affiliation: Department of Clinical Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Antonij
authors.initials: A
authors.lastname: Slavcev
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Gazdic
authors.affiliation: Department of Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Peter
authors.initials: P
authors.lastname: Ivak
authors.affiliation: Department of Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Ivan
authors.initials: I
authors.lastname: Netuka
mesh_terms: D000328:Adult; D000906:Antibodies / Q000378:metabolism*; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D006333:Heart Failure / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation / Q000401:mortality; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000209:etiology; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000401:mortality; D044140:Receptor, Angiotensin, Type 1 / Q000276:immunology*; D014181:Transplantation Immunology / Q000276:immunology
chemical_list: D000906:Antibodies; D006680:HLA Antigens; D044140:Receptor, Angiotensin, Type 1
keywords: Angiotensin II Type 1 Receptor; Heart Mate II; LVAD; heart transplantation